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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419582
Report Date: 06/25/2024
Date Signed: 06/25/2024 10:01:18 AM

Document Has Been Signed on 06/25/2024 10:01 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:COHEN FAMILY CHILD CAREFACILITY NUMBER:
197419582
ADMINISTRATOR/
DIRECTOR:		COHEN, NECHAMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 384-5171
CITY:LOS ANGELESSTATE: CAZIP CODE:
90036
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
06/25/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee, Nechama CohenTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Priscilla Ochoa and Kruz Long conducted an unannounced case management inspection to the facility on this date. LPAs conducted this visit to cite Reporting Requirements for an incident that occurred on February 7, 2024. Licensee failed to report an open investigation to the Department, therefore LPAs are citing for failure to comply with Reporting Requirements.

Deficiencies were cited in accordance with California Code of Regulations Title 22. See 809-D http://www.ccld.ca.gov/

According to the licensee she was unaware that she had to report the incident. The licensee will email LIC624 to [email protected]. LPA reviewed reporting requirements with licensee and provided the Unusual Incident Report form to be submitted by 6/26/2024.

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 conducted with the licensee, Nechama Cohen. A copy of this report and appeal rights discussed and provided to the licensee.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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 06/25/2024 10:01 AM - It Cannot Be Edited


Created By: Priscilla Ochoa On 06/24/2024 at 03:01 PM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: COHEN FAMILY CHILD CARE
FACILITY NUMBER: 197419582

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2024
Section Cited
CCR
102416.2(b)

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Reporting Requirements. The licensee shall report to the Department any of the events as specified in Health and Safety Code Section 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home. Licensee failed to report an incident that occurred on February 7, 2024.
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Per licensee, she was unaware that she needed to report the incident. Licensee must submit LIC624 to the departmnet via emial [email protected] no later than 6/26/2024

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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:Ana Chico
LICENSING EVALUATOR NAME:Priscilla Ochoa
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2024


LIC809 (FAS) - (06/04)
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