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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020584
Report Date: 02/23/2022
Date Signed: 02/23/2022 05:53:39 PM

Document Has Been Signed on 02/23/2022 05:53 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:HERNANDEZ GUZMAN FAMILY CHILD CAREFACILITY NUMBER:
198020584
ADMINISTRATOR:BESSIE HERNANDEZ GUZMANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 462-1664
CITY:WEST COVINASTATE: CAZIP CODE:
91790
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
02/23/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:31 PM
MET WITH:Bessie Hernandez GuzmanTIME COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPAs) Cynthia Reyes and Carolyn Tuba, conducted an unannounced initial 10 day inspection to investigate the above complaint allegation. LPAs met with Bessie Hernandez Guzman, Licensee. A Covid-19 risk assessment was conducted prior to entering the facility. Due to COVID- 19 precautionary measures were taken during the entire inspection and all individuals present during this inspection wore appropriate personal protective equipment. LPAs were guided to the day care room where 12 children and licensee assistant daughter Cynthia was observed. Census, names, and ages of the children were taken. The purpose of the inspection was announced.

The facility is being cited for, during this inspection LPAs observed an adult in the home that is not fingerprint cleared. Licensee stated her grandmother arrived on 02/20/2022. Un-Fingerprinted adult stated she is staying until the end of this year or maybe longer.

During interviews conducted with day care staff, disclosures reveal that on 01/31/2022, licensee and child #1 had Covid-19 and the day care closed from 01/30-02/07/2022.

A technical Advisory is being given for failure to report the required unusual incident information to the Department within the required telephone call, within 24 hours of the incident and the written report within 7 days of the incident.

The deficiencies listed on the following page is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Licensee Bessie Hernandez Guzman.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Cynthia Reyes
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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 02/23/2022 05:53 PM - It Cannot Be Edited


Created By: Cynthia Reyes On 02/23/2022 at 05:03 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: HERNANDEZ GUZMAN FAMILY CHILD CARE
FACILITY NUMBER: 198020584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2022
Section Cited
CCR
102370(d)(1)

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102370(d)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as
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Licensee, will submit proof of documentation for fingerprint clearance processing and communication with Guardian System of Staff #1 to LPA by 02/25/2022 via email.
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evidence by: LPA called the Regional Office and determined through Licensing Information System (LIS) that Staff #1 is not fingerprinted.This poses an immediate risk to the health and safety of children 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:Christina Gabelman
LICENSING EVALUATOR NAME:Cynthia Reyes
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022


LIC809 (FAS) - (06/04)
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