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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192009634
Report Date: 12/23/2021
Date Signed: 12/23/2021 03:34:34 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:OSEGUERA FAMILY CHILD CAREFACILITY NUMBER:
192009634
ADMINISTRATOR:OSEGUERA, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 428-9141
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:14CENSUS: 2DATE:
12/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Licensee - Patricia OseaguraTIME COMPLETED:
03:45 PM
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Licensing program analyst (LPA) R.Derraco conducted an unannounced complaint inspection to the above address on 12/23/21 at 2:55 PM. After the inspection was concluded, licensee stated that she would like be on inactive status for a year because of medical reasons and the pandemic. Licensee provided a completed LIC 9211 to LPA.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy DerracoTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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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