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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013463
Report Date: 05/08/2019
Date Signed: 05/08/2019 12:18:27 PM

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:COALICION DE LATINO AMERICANOS, INC.FACILITY NUMBER:
198013463
ADMINISTRATOR:ANA POPPERFACILITY TYPE:
850
ADDRESS:7413 JABONERIA ROADTELEPHONE:
(562) 928-5138
CITY:BELL GARDENSSTATE: CAZIP CODE:
90201
CAPACITY:48CENSUS: 0DATE:
05/08/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:Will RenteriaTIME COMPLETED:
12:32 PM
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A Case Management inspection was conducted by Licensing Program Analyst, Timothy Fields. LPA met with Director Will Renteria. The purpose of today's inspection was to conduct an interview with a staff member and obtain signatures. The individual to be interviewed was not present. Contact information was obtained. The facility was transitioning to the afternoon session. No children were signed in to care at the time of the visit.

Exit interview conducted with director. Appeal Rights provided and explained. Notice of Site Visit must be posted for (30) days. Failure to do so may result in a $100.00 civil penalty.

Web site address to order forms: http://www.dss.cahwnet.gov/cdssweb/On-lineFor_293.htm#l
INTERNET ADDRESS: http://www.ccld.ca.gov – To access licensing forms, updates and Title 22.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Timothy FieldsTELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2019
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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