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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400421
Report Date: 03/13/2023
Date Signed: 03/13/2023 12:07:28 PM

Document Has Been Signed on 03/13/2023 12:07 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:AMARO FAMILY CHILD CAREFACILITY NUMBER:
198400421
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
03/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Licensee - Mario AmaroTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing program analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 03/13/23. LPA began case managment visit at 11:15 AM and met with licensee Mario Amaro. An assistant and 2 children were observed in the home during inspection. The home was observed to be clean and in good repair.

The purpose of this visit is to issue a citation to licensee in regards with failing to report an unusual incident. Licensee states that Long Beach Police Department (LBPD) had contacted him by telephone on 03/02/23 to ask questions about an incident that was reported to Community Care Licensing Division (CCLD)as a complaint on 12/09/22. When asked why licensee did not report the incident to CCLD, his response was that he was told by LBPD that they would get in contact with CCLD to obtain additional information. LPA advised licensee that a citation will be issued under California Code of Regualtion (CCR) section 102416.2(b)(3)(C).

Exit interview conducted, appeal rights provided and report was reviewed with the licensee Mario Amaro.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2023
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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Document Has Been Signed on 03/13/2023 12:07 PM - It Cannot Be Edited


Created By: Randy Derraco On 03/13/2023 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: AMARO FAMILY CHILD CARE
FACILITY NUMBER: 198400421

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
102416.2(b)(3)(C)

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102416.2 Reporting Requirements (b) the Licensee shall report to the Department any of the events...(3) Health and Safety Code Section 1597.467(b)(1) provides in part...(C) any unusual incident ... This requirement is not met as evidenced by:
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LPA reviewed regulation with licensee
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Based on observation, interview and record review, the licensee did not report that he had been contacted by LBPD regarding the personal rights of a child in care, which poses and potential Health, safety and/or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Karen Chambers
LICENSING EVALUATOR NAME:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023


LIC809 (FAS) - (06/04)
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