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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020044
Report Date: 05/29/2024
Date Signed: 05/29/2024 05:52:18 PM

Document Has Been Signed on 05/29/2024 05:52 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ALVAREZ LEIVA FAMILY CHILD CAREFACILITY NUMBER:
198020044
ADMINISTRATOR/
DIRECTOR:		ALVAREZ LEIVA,S & CARLOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 448-4169
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
05/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
05:30 PM
MET WITH:Siomara Leiva - Alvarez, LicenseeTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Franchesca White arrived at the above facility for the purpose of an unannounced case management visit. LPA White announced the purpose of the visit and was granted entry into the facility by Licensee Siomara Leiva. There were 3 children present at the time of inspection. There were 1 staff members present at the time of inspection. All residence in the home have current criminal background clearance.

The regulation for reporting requirements states, “Health and Safety Code Section 1597.467(b)(1) provides in part: "A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events:
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."

Licensee Siomara Leiva was notified by a parent that a day care child’s personal rights were allegedly violated, and licensee failed to notify the department of an unusual incident report. This is a potential health and safety risk to persons in care.

After, a complaint was filed against the facility. Licensee made a report to DCFS on the parent of the day care child and sibling months after the being told of the incident. The department views Licensee's actions as retaliation, and hereby issue a technical violation (warning).

Therefore, Licensee did not meet the requirement of the department. California Code of Regulations, Title 22, Division 12, Chapter 1, section 102416.2, and 102419(a)(5) is being cited on the attached LIC 809D.

The report was reviewed with Licensee Siomara Leiva - Alvarez. A copy of the report, appeal rights, and notice of site visit was given to Licensee Siomara Leiva - Alvarez.
.....................................Report Ends 1 of 1 Page......................................................................
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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Document Has Been Signed on 05/29/2024 05:52 PM - It Cannot Be Edited


Created By: Franchesca White On 05/29/2024 at 05:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ALVAREZ LEIVA FAMILY CHILD CARE
FACILITY NUMBER: 198020044

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2024
Section Cited
CCR
102416.2(b)(3)

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(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child."

This requirement was not met as evidence by:
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Licensee states that she will make the report to the report to the department, and review the department video on reporting requirements and provide a written summary to LPA White on or before the POC due date.
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Based on interview , and record review Licensee did not report an unusual incident report to the department in a timely fashion which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Gibbs
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 05/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/29/2024


LIC809 (FAS) - (06/04)
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