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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020754
Report Date: 12/10/2021
Date Signed: 12/10/2021 09:26:13 AM

Document Has Been Signed on 12/10/2021 09:26 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CAMARENA FAMILY CHILD CAREFACILITY NUMBER:
198020754
ADMINISTRATOR:MIRNA CAMARENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 394-0945
CITY:LOS ANGELESSTATE: CAZIP CODE:
90065
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
12/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Mirna Camarena, ApplicantTIME COMPLETED:
09:42 AM
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At 8:45AM on 12/10/2021 Licensing Program Analyst (LPA) Lissete Gonzalez conducted an announced Case Management inspection to follow up on usage of the exterior partial restroom noted on the Pre-Licensing visit on 11/24/2021. LPA met with applicant, Mirna Camarena, to whom the purpose of the visit was announced.

On 11/24/2021, LPA observed a partial restroom located on the outdoor area on the side of the home. The partial restroom was observed to have a child size toilet and sink fixtures with plumbing. LPA observed the partial restroom to be covered however, there is no door available on the restroom. The fire inspection report received by the department included the facility outdoor sketch with the outdoor partial restroom and was stamped as “approved” by the fire inspector. Based on observation and information obtained, the Department has determined the outdoor partial restroom can be used by younger children who are potty training when the children are outdoors as it is accessible. The primary restroom to be used will remain as the indoor restroom. School age children will not have privacy using the outdoor partial restroom, therefore, school age children must use the primary indoor restroom only. LPA obtained a signed declaration from applicant, Mirna Camarena regarding usage of the outdoor partial restroom.

Exit interview conducted and report was reviewed with the applicant, Mirna Camarena.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Lissete Gonzalez
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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