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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400251
Report Date: 12/16/2021
Date Signed: 12/16/2021 09:50:37 AM

Document Has Been Signed on 12/16/2021 09:50 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:CUEVAS FAMILY CHILD CAREFACILITY NUMBER:
198400251
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 1CENSUS: 0DATE:
12/16/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Maria Cuevas, LicenseeTIME COMPLETED:
10:00 AM
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THIS INSPECTION WAS CONDUCTED IN SPANISH

Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management visit on 12/16/21. LPA Ramos met with Licensee, Maria Cuevas, who guided analyst on a tour of the facility. There were no children present during the visit. Licensee's adult daughter was also present. All adults present have obtained a criminal record clearance.

The purpose of the visit was to inspect the home due to Licensee reporting that they remodeled their home. Licensee reported to the department on 11/24/21 that remodelling will take place on 11/25/21 and be completed on 11/28/21. LPA attempted an in person inspection on 12/07/21 but was unable to complete the inspection due to Licensee not being home at their home.

LPA observed that the Licensee a 36 inch wall and door and converted a closet into a hallway to have easier access and observation of the rooms and the home. The construction was complete during the inspection. No children were present, therefore, there was no immediate risk to the health, safety or personal rights of children in care observed during today's visit. Licensee did disclose that they do plan to paint the hallway but will do so when there are no children in care present. Licensee provided an updated facility sketch.

There were no deficiencies cited during today’s inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Maria Cuevas, Licensee, including, but not limited to Provider Rights, Appeal Procedures .

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Rita Ramos
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2021
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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