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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198002152
Report Date: 07/22/2022
Date Signed: 07/22/2022 12:15:18 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/22/2022 12:15 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LIZARRAGA, ESTELA FAMILY DAY CAREFACILITY NUMBER:
198002152
ADMINISTRATOR:LIZARRAGA, ESTELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 685-2444
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:14CENSUS: 0DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Estela Lizarraga, LicenseeTIME COMPLETED:
12:20 PM
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On July 22, 2022 at 10:55 am Licensing Program Analysts (LPAs) Monique Ayala and Veronica MartinezGarza conducted an announced required 1 year inspection. A risk assessment was conducted prior to entering the facility. LPAs met with licensee Estela Lizarraga who stated that she is inactive. LPAs asked licensee if she submitted the inactive status form and Licensee stated yes but doesn't have a copy. Licensee didn't allow LPAs to tour the facility to ensure that no day care children were present. Per licensee, she is remodeling her home. Licensee stated she would like to surrender her license and reapply at a later date.

LPAs provided licensee with a declaration and asked licensee to surrender her license to LPAs but licensee stated that she couldn't locate her license. Licensee will submit her license to LPAs once she locates license.

An exit interview was conducted and a copy of this report was provided to licensee, Estela Lizarraga along with Notice of Site Visit
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Veronica Martinez-GarzaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2022
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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