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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191500557
Report Date: 05/01/2023
Date Signed: 05/01/2023 10:21:22 AM

Document Has Been Signed on 05/01/2023 10:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:FIRST CHRISTIAN CHURCH CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191500557
ADMINISTRATOR:LILIANA VASQUEZFACILITY TYPE:
850
ADDRESS:1751 N PARK AVTELEPHONE:
(909) 629-3636
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 60TOTAL ENROLLED CHILDREN: 11CENSUS: 7DATE:
05/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Patricia UbaTIME COMPLETED:
10:30 AM
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On 5/1/2023 at 9:15 am Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced Case Management visit to amend two (2) LIC9099 reports to rectify and correct information provided on the initial reports given during the visit conducted on 3/7/2023 for a Complainant inspection. LPA met with staff as the Director, Patricia Uba was unavailable and later arrived at 10:00 am. Staff member guided LPA and a census of 7 children and 1 staff were present. A Covid Risk assessment had been conducted and LPA wore protected gear.

An exit interview was conducted, and a copy of this report was provided, along with Notice of Site Visit and Appeal Rights to the Director, Patricia Uba.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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