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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411237
Report Date: 07/10/2019
Date Signed: 09/16/2019 04:26:52 PM

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: 7DATE:
07/10/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:licenseeTIME COMPLETED:
09:35 AM
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On 7/10/2019 Licensing Program Analyst (LPA) Chandler made an unannounced visit to the Morales FCCH for the purpose of delivering an ORDER TO INDIVIDUAL OF IMMEDIATE EXCLUSION FROM ALL FACILITIES for individual; Juan Arteaga.

A signed declaration statement was received from licensee, stating she understands the contents of the letter.

The letter was discussed and delivered to licensee Gloria Morales and the visit was concluded.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2019
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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