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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414248
Report Date: 02/27/2025
Date Signed: 03/07/2025 09:54:40 AM

Document Has Been Signed on 03/07/2025 09:54 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:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
197414248
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, MARIA & SUSANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 398-4910
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
02/27/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:53 AM
MET WITH:Maria Chavez/Susana OrtizTIME VISIT/
INSPECTION COMPLETED:
01:04 PM
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On 02/27/2025 Licensing Program Analyst (LPA) Ranita Richmond arrived at the home to conduct a Plan of Correction visit and was met by Licensees Maria Chavez and Susana Ortiz. LPA observed 2 children in care being supervised and cared for by licensees.

On 01/08/2025, Licensee was cited for the following:
1. Licensee will ensure that each child has a complete file including all of the Title 22 required documents (immunization records).
2. Licensee will ensure updated 1st aid/CPR is on file for licensee.
3. Licensee will ensure that all detergents, cleaning compounds, etc. are inaccessible to children in care.
4. Licensee shall document and file infant sleep chart for children 24 months and under in care.

During visit LPA Richmond observed the following:
1. LPA observed 1st aid/cpr completed 3/20/23. Licensee provided copy via photo.
2. Children's files are complete and include immunization records.

2 of 4 Citations issued on 1/08/2025 has been cleared.

An exit interview was conducted. A copy of this report, notice of site visit, deficiencies clearance letters were discussed and provided to Licensee Maria Chavez and Susana Ortiz.
Claudia EscobedoTELEPHONE: (424) 301-3044
Ranita RichmondTELEPHONE: (424) 301-3065
DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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