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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020725
Report Date: 11/05/2021
Date Signed: 11/05/2021 02:06:57 PM

Document Has Been Signed on 11/05/2021 02:06 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BARRAGAN FAMILY CHILD CAREFACILITY NUMBER:
198020725
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Applicant, Jacqueline BarraganTIME COMPLETED:
02:10 PM
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Subsequent pre-licensing inspection conducted by Licensing Program Analyst (LPA) Jose Guzman. The purpose of this inspection is to ensure corrections noted on report dated 10/27/2021 are complete. Risk assessment was conducted prior to entry. LPA met with Applicant, Jacqueline Barragan. LPA toured the facility and observed a bolted fireplace screen making fireplace inaccessible, removal of poisons, received an updated indoor/outdoor facility sketch to include the guest home, updated application to include all adults living in the home, completed outdoor patio, criminal record clearance for all adults living in the home, and the storage room was cleared.

Applicant was also informed that every adult at the facility must have a criminal record clearance prior to living or visiting the facility and that children in care will not have access to the guest home.

Facility is ready to be licensed.

An exit interview conducted with the Applicant, Jacqueline Barragan.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jose Guzman
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2021
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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