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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000036
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:18:34 PM

Document Has Been Signed on 12/07/2023 04:18 PM - 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:FAJARDO FAMILY CHILD CAREFACILITY NUMBER:
192000036
ADMINISTRATOR:FAJARDO, NAY-YIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 917-0149
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
12/07/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Nay-Yi FajardoTIME COMPLETED:
04:25 PM
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On 12/7/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure the 3 Type B deficiencies cited on 11/30/2023 for an annual visit have been corrected. A COVID risk assessment was conducted. LPA met with Licensee, Nay-Yi Fajardo. LPA observed 12 children in care with 2 additional adults.

During the visit LPA, was provided with Mandated Reporting Training Certificates that were completed for Licensee, 2 Assistants and Licensee’s spouse which expires December 2025. A 15-minute sleep log was provided documenting a child in care who is under the age of 2 years. Licensee provided proof of the receipt of a new fire extinguisher purchased 12/4/2023. Licensee is still working on providing proof of immunization records for the Licensee's MMR, thel adults working in the home and her spouse who also assist with the children.POC is due on 12/15/2023. LPA provided consultation to Licensee for questions she had at the time of the visit. Interview Questions for Care Tool was conducted during the visit.

LPA cleared the deficiency on this date and provided a copy of the Licensing Report to Licensee. LPA also issued POC clearance letter during the visit.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

A notice of site visit was given to Licensee and must remain posted for 30 days.



Exit interview conducted and report was reviewed with the Licensee, Nay-Yi Fajardo.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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