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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015243
Report Date: 09/09/2021
Date Signed: 09/09/2021 11:29:32 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:MADRIGAL FAMILY CHILD CAREFACILITY NUMBER:
198015243
ADMINISTRATOR:MADRIGAL, ALMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 409-9102
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 0DATE:
09/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Alma Madrigal, LicenseeTIME COMPLETED:
11:45 AM
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An Unannounced Required 1Year Inspection was conducted on this day by Licensing Program Analysts (LPA) A. Lucero. On the date of this inspection, LPAs met with Licensee Alma Madrigal. There were no children present during today's inspection.

Licensee stated to LPA that the facility has not been in operation and would like to put her facility on Inactive Status. LPA determined that the facility does not have any children enrolled. LPA obtained LIC 9211 during inspection.

Licensee agrees to the following:
I. Will not provide child care for which a license is required until license is reactivated.
II. Will continue to promptly pay the annual license fee.
III. Will inform Licensing office of any changes in the above dates prior to re-opening facility by submitting a new LIC 9211
IV. I will be in compliance with all licensing laws and regulations upon re-opening facility, including but not limited to:
· Ensuring all adult staff and residents, including children who turn 18 during the inactive period, have criminal record clearances
· Maintaining current CPR and First Aid certifications
· Maintaining a current fire extinguisher and functioning smoke alarms

Exit interview was conducted with Licensee. LIC 9211 given, Appeal Rights explained & provided. The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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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