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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198019500
Report Date:
12/15/2022
Date Signed:
12/16/2022 07:09:11 AM
Document Has Been Signed on
12/16/2022 07:09 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:
DE LUNA FAMILY CHILD CARE
FACILITY NUMBER:
198019500
ADMINISTRATOR:
GUIA JEAN DE LUNA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(562) 357-8896
CITY:
LONG BEACH
STATE:
CA
ZIP CODE:
90804
CAPACITY:
14
CENSUS:
DATE:
12/15/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:30 AM
MET WITH:
TIME COMPLETED:
09:00 AM
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Attempted Visit
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3858
LICENSING EVALUATOR NAME:
Dayna Chambers
TELEPHONE:
(323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE:
12/15/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
12/15/2022
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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