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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005818
Report Date: 06/29/2022
Date Signed: 06/29/2022 01:30:42 PM


Document Has Been Signed on 06/29/2022 01:30 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:FLORES FAMILY DAY CAREFACILITY NUMBER:
198005818
ADMINISTRATOR:FLORES,LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 828-0862
CITY:BELLSTATE: CAZIP CODE:
90201
CAPACITY:14CENSUS: 0DATE:
06/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Linda Flores, LicenseeTIME COMPLETED:
01:45 PM
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Inspection Conducted in Spanish

Licensing Program Analyst (LPA) Alicia Mooberry arrived at the above facility for the purpose of conducting a Required Annual inspection. Upon arrival, LPA met with Linda Flores, Licensee, who stated that the facility has not operated since last year and does not have any children in care. LPA did not observe any children in care.

Licensee is requesting to apply for Inactive Status. LPA provided the LIC 9211, per licensee, they will complete and mail to LPA by 7/5/22. LPA discussed the conditions of Inactive status of a facility with licensee. Including not providing active child care. Facility fees shall be paid during the inactive period. Licensee is responsible to contact and update the department in regard to her facility operation. LPA provided contact information for the local Regional Office and LPA contact number.

LPA provided LIC 279 and LIC 279B due to the information on the original forms is out of date. Per licensee, the documents will be updated and sent to LPA by Tuesday 7/5/22. Licensee provided updated phone number.

To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

Exit interview was conducted with Linda Flores, Licensee.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2022
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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