<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006988
Report Date: 02/02/2023
Date Signed: 02/02/2023 10:13:19 AM


Document Has Been Signed on 02/02/2023 10:13 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CHOI FAMILY CHILD CAREFACILITY NUMBER:
198006988
ADMINISTRATOR:CHOI, CHUFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 283-0756
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:14CENSUS: 0DATE:
02/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Chu ChoiTIME COMPLETED:
09:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Case management conducted by Licensing Program Analyst Jennifer Hua. LPA attempted to conducted an annual required visit. LPA met with licensee who informed LPA that the day care is currently closed. However, licensee still wants to keep the license. Licensee stated that the day care has been closed since last September. Licensee stated she is currently attending school. LPA explained inactive licensee status. Licensee requested to be placed on inactive licensee status from 2/2/2023 - 2/2/2024.

Request for Inactive License Status Form provided during this visit. Licensee completed form during visit.

NOTE: Due to Printer issue, report and Inactive License Status form will be emailed and sent to licensee. .

An exit interview conducted, copy of report given.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Jennifer HuaTELEPHONE: (323) 981-3375
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1