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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011849
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:23:14 PM


Document Has Been Signed on 08/07/2023 03:23 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:GONZALEZ FAMILY CHILD CAREFACILITY NUMBER:
198011849
ADMINISTRATOR:GONZALEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 232-4043
CITY:PARAMOUNTSTATE: CAZIP CODE:
90723
CAPACITY:14CENSUS: 3DATE:
08/07/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Maria Gonzalez, LicenseeTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPAs) Susann Sanchez and Jeanette Estrada conducted a case management visit. LPAs observed 3 children present. Also present was Licensee son Paul Perez, Licensee husband Diego Perez.

At 3:07pm, a Social Worker Melissa of Masada Homes arrived at the facility. Per Masada is here for 45 minutes today 08/07/23.

The purpose of this visit is that the Department is issuing a civil penalty per Health and Safety Code 1569.99(f) in the amount of $2,000. A copy of the LIC 421D was signed and given to Licensee Maria Gonzalez.

Exit interview conducted. A copy of the report, along with Appeal rights provided. Licensee Maria Gonzalez signature on this report acknowledges receipt of the Appeal Rights, found on page two of LIC 421D. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2023
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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