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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021130
Report Date: 02/15/2023
Date Signed: 02/15/2023 10:05:30 AM

Document Has Been Signed on 02/15/2023 10:05 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROBLES FAMILY CHILD CAREFACILITY NUMBER:
198021130
ADMINISTRATOR:MARIA ROBLESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 531-6983
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
02/15/2023
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Maria RoblesTIME COMPLETED:
10:15 AM
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On 2/15/2023 at 8:55 am, Licensing Program Analysts (LPAs) Carolyn Tuba and Mary Silva conducted an announced Plan of Correction for a prior visit conducted on 2/3/2023 for Change of Location/Pre-Licensing inspection (previous license number 198018637). A COVID risk assessment was conducted prior to entry and appropriate personal protective equipment were used. Applicant gave a tour of the backyard, the hallway inside the home and the playroom. There was 1 child in care, which is a granddaughter of the applicant and lives in the home. There were 2 additional adults that have been fingerprint cleared.

The purpose of today’s visit is to inspect and evaluate the facility for plan of correction for the unsafe equipment in the back yard, the completed dog run to keep away from the children. The pile of items and boxes has been cleared out of the hallway inside of the home, and the parent board is displayed in the playroom (LPA took photos). Applicant provided the LPAs additional documents needed to be licensed. (Updated Application, Immunization Records, Receipt for Health.Safety, Nutrition and Lead Training, and Criminal Background Clearance Documentation).

A large family child care license will be granted after final review of all documentation. Once licensed, the applicant is required to comply with the terms and limitations stated on the license.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted, appeal rights and a copy of this report was given to Applicant, Maria Robles.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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