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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014687
Report Date: 03/10/2020
Date Signed: 03/10/2020 11:03:49 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:NEVAREZ FAMILY CHILD CAREFACILITY NUMBER:
198014687
ADMINISTRATOR:ELIZABETH NEVAREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 263-9490
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:14CENSUS: 3DATE:
03/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Elizabeth NavarezTIME COMPLETED:
11:18 AM
NARRATIVE
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Licensing Program Analysts (LPA's) Jennifer Anguiano and Lissete Gonzalez conducted an unannounced case management inspection for the purpose of addressing an Exemption Denial for Yadir Nevarez, Licensee, who guided LPA on a tour of the facility at approximately 10:30am.

During the course of the inspection LPAs reviewed the exemption denial with the licensee. According to the licensee, individual has never worked or lived in the home. LPA obtained a signed Confirmation of Removal for Yadir Navarez (LIC 300B) from Licensee during today’s visit. Licensee understands that Yadir Nevarez is prohibited from being at the facility or having contacts with clients of any facility licensed by the Department.

No deficiencies cited in accordance with Title 22 California Code of Regulations.

Exit interview conducted with licensee Elizabeth Navarez. Appeal rights explained. Notice of Site Visit provided and must be posted for 30 days.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Jennifer AnguianoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2020
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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