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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400298
Report Date: 05/11/2021
Date Signed: 05/11/2021 03:31:23 PM

Document Has Been Signed on 05/11/2021 03:31 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
198400298
ADMINISTRATOR:ANTONIA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 740-6168
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/11/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Antonia Jimenez; ApplicantTIME COMPLETED:
10:49 AM
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Licensing Program Analyst (LPA) Reiko Jones-Modeste conducted a CASE MANAGEMENT inspection via tele-inspection using FACETIME due to SOE to address several action items discussed during PRELICENSING.

LPA observed the Applicant at the facility. During this tele-inspection the Applicant guided the LPA on a tour of the facility to inspect the following action items discussed during the initial PRELICENSING inspection dated 3/09/21:
1. COVID_19 (postings, isolation, intake)
2. Bathroom cabinet hazards
3. Infant sleep equipment
4. Off-Limits areas accessible(locks, barricades)
5. Required Postings: Missing Disaster Drill log
6. No immunizations for residents/minor children Armando, Santiago and Fernando Jr.
7. LIC 508 (Fernando Jr.)
8. Control of Property

LPA observed and discussed the following corrections:
1. COVID_19 postings at the facility entrance including sanitizer, no-touch thermometer, gloves and disposable masks and required postings on front porch with a designated isolation area in the front bedroom
2. One GRACO Pack-n-Play crib
3. Off-Limits Rear bedroom locked and barricaded with chain
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Reiko Jones
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER: 198400298
VISIT DATE: 05/11/2021
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4. Children's restroom cabinets locked and inaccessible with child safety locks
5. Disaster Drill Log posted
6. Immunizations rcv'd via mail
7. LIC 508 (Fernando Jr. and Control of Property to be mailed to MPSW

Once licensed, the Applicant is required to adhere to the terms and limitations as stated on the license.
Exit interview was conducted with the Applicant. Upon receipt the Applicant shall post the Notice of Site Visit. This report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report and all other licensing reports must be made available to the public for 3 years.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Reiko Jones
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021
LIC809 (FAS) - (06/04)
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