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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407003
Report Date: 03/13/2024
Date Signed: 03/14/2024 08:52:14 AM


Document Has Been Signed on 03/14/2024 08:52 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:PADILLA FAMILY CHILD CAREFACILITY NUMBER:
197407003
ADMINISTRATOR:PADILLA, ELISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 204-6083
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:14CENSUS: 1DATE:
03/13/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Padilla, ElisaTIME COMPLETED:
10:45 AM
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On March 13,2024, LPA's, Tyra Chavies and Lisa Clayton, conducted an unannounced Required- 3 year visit the home of with Licensee, Padilla, Elisa.

LPA's arrived and knocked on front door twice. LPA's then went towards back of the home and found the doors open. LPA's were greeted by licensee. LPA's walked in home and observed one child sitting in living room area.

Licensee stated she is providing care to one child and does not want to provide care to more children. She is surrendering her license as of 3/13/2024.
LPA, Tyra Chavies, explained that:
Providing child care without a license is illegal. However, you do not need a license in the following situations:
(1) The children being cared for are related by blood or marriage to you.
(2) The children being cared for are from one family in addition to your own children.
(3) The care provided to children is part of a cooperative arrangement between parents for the care of their children where each parent, or set of parents, rotates as the responsible care giver with respect to all the children in the cooperative, and no payment for the care is involved.

Licensee has been advised the CCL will be sending her a letter regarding the surrender of her license via the USPS.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Tyra ChaviesTELEPHONE: 424-301-3204
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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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