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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001144
Report Date: 09/24/2020
Date Signed: 09/24/2020 12:14:35 PM

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:PLASENCIA FAMILY CHILD CAREFACILITY NUMBER:
192001144
ADMINISTRATOR:PLASENCIA, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 531-6548
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:14CENSUS: DATE:
09/24/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Dolores Placentia, LicenseeTIME COMPLETED:
12:30 PM
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On September 24, 2020 at 11:40AM, Licensing Program Analyst LPA Steven Rodriguez conducted an unannounced case management visit for the purpose of obtaining current contact information to update the licensees facility file and to determine operational status during Covid-19, and the Bobcat Fires. LPA met with Licensee Dolores Placentia.

Licensee indicates she is currently operating and did not close at any time during the Covid-19 pandemic or the Bobcat fires. She currently has 8 children in care today and is licensed for 14 capacity.

Licensee stated her days and hours of operation are Monday-Friday 6am-530pm

Licensee provided her cell phone number and email address.

Exit interview was conducted in person with licensee Dolores Placentia. A copy of this report (LIC 809) and Appeal Rights (LIC 9058) were discussed, signed, printed and given on this date.



All precautionary measures regarding Covid-19 were discussed and taken by LPA and licensee on this date.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Steven RodriguezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020
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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