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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411237
Report Date: 07/15/2019
Date Signed: 07/15/2019 09:27:48 AM

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:MORALES FAMILY CHILD CAREFACILITY NUMBER:
197411237
ADMINISTRATOR:MORALES, GLORIA O.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 706-8612
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 4DATE:
07/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:licenseeTIME COMPLETED:
09:02 AM
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On 7/15/2019 Licensing Program Analyst (LPA) Chandler made an unannounced visit to the Morales family day care for the purpose of following up on an immediate exclusion removal. Upon arrival present in the home was the licensee's assistant and 3 day care children. The licensee was not available upon arrival, she arrived approximately 3 minutes into the visit. Licensee Morales guided LPA on a tour of the home according to the facility sketch.

LPA did not observe the excluded individual in any areas of the home. Licensee states that the individual is residing at her adult sons home. Licensee provided LPA with the resident address.

The visit was concluded.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
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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