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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400632
Report Date: 05/05/2023
Date Signed: 05/05/2023 02:17:47 PM

Document Has Been Signed on 05/05/2023 02:17 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:CONTRERAS FAMILY CHILD CAREFACILITY NUMBER:
198400632
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
05/05/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee - Ericka ContrerasTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management visit to the above mentioned facility on 05/05/23. LPA arrived at the facility at 1:10PM and was met by licensee, Ericka Contreras. LPA observed 1 adult and 3 children in care. Adults that reside in the home have been noted and discussed. LPA observed the home to be clean and in good repair.

The purpose of this visit is to observed the outdoor play structure and play area located in the back yard. LPA obtained a copy of the updated facility sketch indicating that the backyard area will now be used by children in care. LPA advised licensee that children playing in the backyard play area as well as children playing indoors must be supervised at all times. LPA observed a children's gate mounted to the wall using screws. LPA also observed two main posts to the wooden climbing structure to be covered with a green soft material to help prevent injury caused by the corners. LPA took photographs of the fence and the climbing structure showing the corrections.

LPA observed the home to be in compliance with Title 22 regulations. LPA did not observe any hazards in the backyard play area.

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 the licensee Ericka Contreras.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 05/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2023
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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