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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019687
Report Date: 12/06/2022
Date Signed: 12/06/2022 10:54:59 AM

Document Has Been Signed on 12/06/2022 10:54 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:ANDREWS FAMILY CHILD CAREFACILITY NUMBER:
198019687
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
12/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Marisol Andrews, LicenseeTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Susann Sanchez conducted a Plan of Correction (POC) inspection on this date 12/06/22. LPA met with Licensee, Marisol Andrews. Licensee gave LPA a tour of the facility. The purpose of the POC inspection was determine if Licensee has corrected the deficiency cited on 11/01/2022. LPA determined the following:
  • LPA reviewed 7 children's files and observed 4 of the 7 LIC 9224 (Acknowledgment of Receipt) in children's files. Per Licensee, with the holidays, other 3 children will be turning in the LIC 9224 by the 12/07/22.
  • LPA observed cots in the living room.
  • LPA observed 15 minute sleeping log.
  • LPA observed Licensee to be operating within ratio. Licensee stated that an infant was dis-enrolled on 11/02/22.
  • Licensee is in the process of enrolling in TSP (Technical Support Program) with the department.

Therefore, based on LPAs records review and observations, POC has been cleared.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee Andrews, but not limited to Provider Rights, Appeal Rights were given.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2022
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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