<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192007930
Report Date: 09/08/2022
Date Signed: 09/08/2022 09:18:21 AM


Document Has Been Signed on 09/08/2022 09:18 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:CISNEROS FAMILY CHILD CAREFACILITY NUMBER:
192007930
ADMINISTRATOR:CISNEROS, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 725-3116
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:14CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Tony Cisneros, Licensee's sonTIME COMPLETED:
09:20 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
An unannounced case management visit conducted today by Licensing Program Analyst, Mireya Garcia. LPA met with Licensee’s adult son, Tony Cisnerors. No day care children were present during the visit. Licensee’s son stated Licensee passed away on July 12, 2021. Per Tony Licensee has NOT cared for children since November of 2020.

LPA Garcia notified Licensee’s son that the license is no longer valid for the operation of a licensed Family Child Care Home and that this Department will be closing case file.

Effective 09/08/2022, the license at 2936 Via San Delarro St Montebello CA 90640 forfeited by operation of law pursuant to Health and Safety Code Section 1596.858. The license is no longer valid, and all provision of care and supervision must cease. The closure of the license means you cannot care for clients unless you reapply and are approved for a new license.

Exit interview was conducted with Licensee’s son, Tony Cisneros.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2022
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