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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197401594
Report Date: 01/20/2023
Date Signed: 01/20/2023 05:16:32 PM


Document Has Been Signed on 01/20/2023 05:16 PM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:HUGHES FAMILY DAY CAREFACILITY NUMBER:
197401594
ADMINISTRATOR:HUGHES, DOROTHYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 217-1528
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:14CENSUS: 0DATE:
01/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Dorothy HughesTIME COMPLETED:
02:15 PM
NARRATIVE
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On January 20, 2023 at 1:45pm, Licensing Program Analyst (LPA) Veronica Wheatley conducted a case management inspection and met with licensee Dorothy Hughes. According to Licensee she would like to surrender the license and close the day care effective today. Licensee's husband Ernest Hughes is also present. LPA did not observe any day care children present.

LPA informed the licensee that the phone number on file was not working. Licensee provided a cellphone number of 310 562 0323.

No violations cited.

Exit interview.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/20/2023
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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