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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014156
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:43:52 AM

Document Has Been Signed on 09/15/2021 11:43 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:PARGA FAMILY CHILD CAREFACILITY NUMBER:
198014156
ADMINISTRATOR:PARGA, TERESAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5624238926
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
09/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Teresa PargaTIME COMPLETED:
12:00 PM
NARRATIVE
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While conducting an investigation for a complaint, Licensing Program Analyst (LPA), T. Tran observed the following deficiency:

Based on record reviewed, licensee and her two employees A2 & A5 (See LIC811) failed to obtain a current CPR & First aid training certificate. CPR & First Aid expired on 07/14/2020. Child C1 & C2 (See LIC857) missing LIC995- Parent's right Receipt form.

Facility was cited a type B deficiency. See Facility Evaluation Report LIC 809D for deficiency cited.

A copy of this report was provided to the licensee and an exit interview was conducted.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/15/2021 11:43 AM - It Cannot Be Edited


Created By: Tiffanie Tran On 09/15/2021 at 11:10 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: PARGA FAMILY CHILD CARE
FACILITY NUMBER: 198014156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2021
Section Cited
CCR
102421

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Child's record
This requirement is not met as evidenced by based on record reviewed C1 and C2 (See LIC857) missing LIC995 in the child's file which poses a potential health and safety risk to children in care.
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Licensee will have parents complete the LIC995 form then submit to LPA by or before 10/13/2021 in order to clear this citation.

Type B
10/13/2021
Section Cited
CCR
102416(c)

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Personnel Requirements
This requirement is not met as evidenced by based on record reviewed licensee, A2, & A5 (see LIC811) failed to obtain a current CPR & First aid training certificate. CPR & First Aid expired on 07/14/2020 which poses a potential health and safety risk to children in care.
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Licensee and employees will complete CPR & First aid training then submit to LPA by or before 10/13/2021 in order to clear this citation.

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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:Trevino Cochran
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 09/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/15/2021


LIC809 (FAS) - (06/04)
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