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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011977
Report Date: 05/17/2023
Date Signed: 05/17/2023 03:51:04 PM


Document Has Been Signed on 05/17/2023 03:51 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CURTIS FAMILY CHILD CAREFACILITY NUMBER:
198011977
ADMINISTRATOR:CURTIS, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 204-5132
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 0DATE:
05/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Octavia CurtisTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Austin Estrada conducted an unannounced case management inspection at the above facility. LPA was originally at the home to conduct an unannounced required one year inspection. LPA met Octavia Curtis, who is the daughter of Licensee Donna Curtis.

Per Octavia Curtis, Licensee Donna Curtis passed away on 4/5/22 and the day care is no longer functioning. LPA asked Octavia Curtis if he could look in the home to make sure no children where in care, in which Octavia Curtis did not allow LPA to do so. LPA did not observe or hear any children while talking to Octavia Curtis at the entrance of the home.

Octavia Curtis has requested that the facility be closed. Octavia Curtis provided a written declaration stating that no kids are in care and her request for the License to be closed. Octavia Curtis did not have the facility license available to give to the LPA. A death certificate was also not available at the time of inspection.

LPA provided Octavia Curtis with a business card with contact information if any questions are needed in the future. A copy of this report was provided to Octavia Curtis.

Report signed by Octavia Curtis.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 9813362
LICENSING EVALUATOR NAME: Austin EstradaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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