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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021022
Report Date: 04/25/2024
Date Signed: 04/25/2024 04:08:33 PM

Document Has Been Signed on 04/25/2024 04:08 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:BRISENO FAMILY CHILD CAREFACILITY NUMBER:
198021022
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
04/25/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:10 PM
MET WITH:Assistant Rosa Covarrubias TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced POC (plan of correction) inspection to insured that the 1 Type A deficiency and 2 Type B deficiencies cited on 04/12/2024 have been cleared. LPA met with Assistant Rosa Covarrubias who guided analysts on a tour of the facility. Licensee, Eloisa Briseno arrived at 3:30 pm and took over the inspection. The following was observed:

- Licensee's Assistant has been fingerprint cleared and associated to the facility as of 4/15/2024.

- Signed LIC 9224 acknowledgment form was observed to be in 8 out 8 files.

- Complete file for assistant was available for review

- Immunizations for child # 1 were available for review

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing Website at: www.ccld.ca.gov.

LPA’s cleared deficiency on this date and provided a copy of the Licensing Report to Eloisa Briseno, licensee. LPA’s issued POC clearance letter during the visit.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Licensee, Eloisa Briseno.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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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