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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016300
Report Date: 05/25/2023
Date Signed: 05/25/2023 10:07:11 AM


Document Has Been Signed on 05/25/2023 10:07 AM - 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:MOORE FAMILY CHILD CAREFACILITY NUMBER:
198016300
ADMINISTRATOR:MOORE, DAYNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 923-2955
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:14CENSUS: 1DATE:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Dayna MooreTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Elka Chavez intended to conduct an unannounced 1 year required inspection on today’s date. LPA met with Dayna Moore who stated that she would like to close her license. LPA Chavez was provided with a formal request from the Licensee.

Exit interview was conducted with Dayna Moore, Licensee.

Notice of Site Visit was given to Licensee and must be posted for 30 days.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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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