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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192007118
Report Date: 12/24/2019
Date Signed: 12/24/2019 09:26:28 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RAMIREZ FAMILY CHILD CAREFACILITY NUMBER:
192007118
ADMINISTRATOR:RAMIREZ, LETICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 585-0232
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY:14CENSUS: 2DATE:
12/24/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:13 AM
MET WITH:Leticia Ramirez_LicenseeTIME COMPLETED:
09:35 AM
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Licensing Program Analyst(LPA) Reiko Jones-Modeste conducted a case management visit to obtain a signature on an amended LIC 9099 Complaint Investigation Report dated 12/4/19.

Upon arrival LPA met with Licensee and observed two children in care.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted with the Licensee, including, but not limited to Appeal Procedures, Site Visit and Initial Appeal Rights.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Reiko JonesTELEPHONE: (323) 558-2739
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2019
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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