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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018393
Report Date: 08/31/2022
Date Signed: 08/31/2022 09:40:50 AM


Document Has Been Signed on 08/31/2022 09:40 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:BARRAGAN FAMILY CHILD CAREFACILITY NUMBER:
198018393
ADMINISTRATOR:BARRAGAN, MANDIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 421-3716
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 0DATE:
08/31/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee, Mandi BarraganTIME COMPLETED:
09:45 AM
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On August 31, 2022 at 9:00 am, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced inspection at the facility noted above and met with Licensee, Mandi Barragan. The purpose of the inspection was to conduct the Required 1 Year inspection however, Licensee requested to be placed on inactive status. Per Licensee, she will submit payment online for her overdue licensing fees of $420.00, and will submit proof of payment to LPA via e-mail. During the inspection, the Licensee submitted the completed Request for Inactive Child Care License Status (LIC 9211). At the time of the inspection, no children were present.

A Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with Licensee, Mandi Barragan.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Monique AyalaTELEPHONE: (323) 246-2016
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2022
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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