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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700359
Report Date: 01/27/2022
Date Signed: 01/27/2022 12:31:16 PM

Document Has Been Signed on 01/27/2022 12:31 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
197700359
ADMINISTRATOR:GARCIA, BELEMFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 902-2724
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 14TOTAL ENROLLED CHILDREN: 32CENSUS: 5DATE:
01/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Belem GarciaTIME COMPLETED:
12:45 PM
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This is an amended report that was issued to Licensee on 11/24/2021 by Licensing Program Analyst (LPA)Isabel Ortega. The purpose of the amended report is to correct the deficiency citations that was issued on 11/24/2021.

LPA Isabel Ortega conducted an inspection for the purpose of delivering the finding for the incident investigation. Upon arrival, LPA was greeted by Belem Garcia.

Below are the conclusions reached by the Palmdale Regional Office: Licensee's Appeal was received at the Palmdale Regional office. The "B" citation and substantiated allegation Personal Rights that alleged Day-care child sustained injury while in care is rendered Unfounded.

On 1/27/22 Licensing Program Analyst (LPA) Isabel Ortega met with Licensee, Belem Garcia for the purpose of amending citation issued on 11/24/21. Present are five children, Licensee, licensee daughter and Licensee's Spouse. During this investigation, LPA Ortega interviewed licensee, parents and other relevant complaint parties, LPA reviewed partial video footage provided by licensee cell phone. It was determined that child in care sustained an injury while in care, licensee was in close proximity to the child and child accidentally fell down the last step.

SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE: DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 197700359
VISIT DATE: 01/27/2022
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Based on information provided including the limited partial video camera footage on licensee's cell phone, interviews obtained by relevant parties, and disclosures made by licensee the Allegation #1 is rendered Unfounded. Although, day-care child sustained injury while in care, Licensee was providing supervision and was in close proximity to child and provided attention when child fell while in care. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report, appeal rights and notice of Site Visit and dismissal letter was provided to the licensee on this date.
SUPERVISORS NAME: Carissa Bell
LICENSING EVALUATOR NAME: Isabel Ortega
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2022
LIC809 (FAS) - (06/04)
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