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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418156
Report Date: 11/14/2019
Date Signed: 11/14/2019 10:44:04 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:JUAREZ FAMILY CHILD CAREFACILITY NUMBER:
197418156
ADMINISTRATOR:JUAREZ, SAN JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 332-0994
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:14CENSUS: 9DATE:
11/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:04 AM
MET WITH:San Juana JuarezTIME COMPLETED:
08:45 AM
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On 11/14/19, Licensing Program Analysts (LPAs) Karren Starks and Helen Estrella for the purpose of conducting a Case Management visit. The Case Management visit is due to receiving a Case Closure notification from CBCB for
CARLOS MOLINA-SOLIS.

LPAs did not observe Mr. Molina-Solis present in the facility. Per the licensee Mr. Molina-Solis was only present to assist with the cleaning around the facility. Licensee stated that once she received the Case Closure notification, Mr. Molina-Solis was no longer allowed to come to the facility.

No deficiency cited.

Copy of report and Notice of Site Visit issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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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