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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015772
Report Date: 09/15/2022
Date Signed: 09/15/2022 10:29:56 AM

Document Has Been Signed on 09/15/2022 10:29 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:AMAYA FAMILY CHILD CAREFACILITY NUMBER:
198015772
ADMINISTRATOR:AMAYA, JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 507-0697
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 1DATE:
09/15/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee - Jose AmayaTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced case management visit to observed correction to citations issued on 08/09/22. LPA was met by licensee Jose Amaya, who guided analyst on a tour of the facility. LPA observed 1 child in care and 1 adult present upon arrival. LPA observed an above ground pool in the front yard. LPA did not observe a ladder or a platform to make the above ground pool accessible. LPA measured the height of the pool walls to be approximately 4 feet high. Per licensee, he will deflate and empty the pool immediately. Licensee states it will take about 2-3 hours to completely deflate and drain the pool. LPA observed licensee deflating and emptying the above ground pool during inspection.

LPA also observed corrections made to citations issued on 08/09/22. LPA observed completed mandated reporter AB1207 compliant training certificates for licensee and assistant. Immunization records were observed for licensee's assistant to be complete. The service tag on the requried 2A-10BC fire extinguisher is dated 08/11/22 and the valve shows fully charged.

LPA provided plan of correction letters for citations issued on 08/09/22.

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

Exit interview conducted and report was reviewed with the licensee Jose Amaya
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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