Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015102
Report Date: 07/08/2016
Date Signed 07/08/2016 10:57:06 AM

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:NAVARRETE FAMILY CHILD CAREFACILITY NUMBER:
198015102
ADMINISTRATOR:NAVARRETE, ANA MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 908-4950
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:14CENSUS: 9DATE:
07/08/2016
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Ana Maria Navarrete (licensee) and Frank Narrette (adult son)TIME COMPLETED:
11:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Ann Dumolt meT with Ms. Navarrete to review the amended report and discuss submitting a request for exception for Child #7 and Child 8 (refer to Confidential Names dated 7/06/2016) On this visit there were 4 infant and 5 preschoolers in care. Son was assisting with the care of the children supervising their water play.

Files reviewed on 3 children not present on last visit (#9, 10, and 11--see Confidential Names dated 7/08/2016) . Children #7 and 8 are not in care this morning. Error noted on Child #6. Date of birth is 2/19/2914 not 12/19/2014 (see Confidential Names dated 7/06/2016)

Licensee showed LPA Dumolt a copy of Child #5's immunization record---guardian of the child brought a copy yesterday.

No deficiencies observed or cited.

Exit inter conducted with Ms. Navarrete. Copy of report and amended report as well as appeal rights given.
SUPERVISOR'S NAME: Joan HayesTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: EAnn DumoltTELEPHONE: (323) 388-6283
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2016
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 1