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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409038
Report Date: 11/06/2024
Date Signed: 11/06/2024 02:37:43 PM

Document Has Been Signed on 11/06/2024 02:37 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:REPOLLO FAMILY CHILD CAREFACILITY NUMBER:
197409038
ADMINISTRATOR/
DIRECTOR:		SUSANA N. REPOLLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 830-9320
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 2DATE:
11/06/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Employee, Prisca Nunez TIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Roberto Luque Avila conducted an unannounced annual inspection to the above facility on 11/6/2024. LPA arrived at the facility at 1:15PM, identified self and met with Prisca Nunez, facility representative who guided analyst on a tour of the facility. LPA provided Licensee with a copy of the LIC 126 Entrance Checklist to help facilitate the inspection. LPA observed 2 children 1 staff upon arrival. Per facility representative, operation hours are 9AM to 6PM. There are 6 children that are currently enrolled.

The licensee is observed to be operating within the license capacity limitations.

Per facility representative the licensee is not currently in the home and will return 11/7/2024

LPA advised the facility representative that the Licensee cannot be gone from the home more than 20 percent of the hours that the facility is providing care per day. In the future licensee needs to inform the department that they will be away from the facility. Technical Violation was given.

This annual will be completed at a later time due to time constraints.

No deficiencies were cited on 11/6/2024

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

Exit interview conducted, appeal rights and report were provided with the facility representative Prisca Nunez.

SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Roberto Luque Avila
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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