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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415454
Report Date: 02/23/2022
Date Signed: 02/23/2022 01:25:35 PM


Document Has Been Signed on 02/23/2022 01:25 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:RIVERA FAMILY CHILD CAREFACILITY NUMBER:
197415454
ADMINISTRATOR:RIVERA, ROSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 293-4839
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 1DATE:
02/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:52 PM
MET WITH:Rosa Rivera, LicenseeTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Case Management-other inspection in Spanish to collect signature on amended report dated November 23, 2021. LPA met with Rosa Rivera, Licensee who provided LPA of tour of the facility. There was 1 child present

The amended report was discussed, and a copy of the amended report was provided to licensee during this inspection.

No deficiencies cited.

Exit interview conducted with Rosa Rivera, Licensee.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2022
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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