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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009050
Report Date: 07/13/2022
Date Signed: 07/13/2022 11:23:12 AM


Document Has Been Signed on 07/13/2022 11:23 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:PADILLA FAMILY CHILD CAREFACILITY NUMBER:
198009050
ADMINISTRATOR:PADILLA, ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 436-2198
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:14CENSUS: 2DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Elizabeth PadillaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst Warren Birks conducted a Case Management inspection. LPA met with Licensee Elizabeth Padilla upon arrival. LPA observed children who were not enrolled in the daycare. The Licensee indicated that she is actually not caring for children in the Summer and is requesting to go Inactive. LPA informed Licensee regarding the inactive process. Licensee submitted an inactive form requesting to go inactive from July 13, 2022 through September 1st, 2022.

LPA informed Licensee to contact us if she wishes to return to active status. LPA also informed Licensee to contact an LPA before opening to get possible updates and information.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Licensee, Elizabeth Padilla. .
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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