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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009512
Report Date: 06/18/2019
Date Signed: 06/18/2019 08:40:58 AM

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:RIVAS FAMILY CHILD CAREFACILITY NUMBER:
198009512
ADMINISTRATOR:RIVAS, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 863-7616
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 6DATE:
06/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Laura Rivas, LicenseeTIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) A. Lucero arrived to the facility and met with Licensee Laura Rivas who guided LPA on an indoor and outdoor tour of the facility. Due to Field Automated System (FAS) issue, LPA obtained a copy of the Annual/Random inspection report dated 04/09/2019.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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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