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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020076
Report Date: 08/01/2019
Date Signed: 08/01/2019 12:28:04 PM

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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
198020076
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
08/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Marianela L. DiazTIME COMPLETED:
12:35 PM
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Licensing Program Analysts (LPAs) Ariel Cazares and Alicia Bailey conducted an unannounced case management inspection on this date. LPAs toured the home and observed 2 children in care. Per licensee, the only individuals living in the home are herself and adult son. LPA verified criminal record clearances for the residents. Licensee made a request to disassociate an individual from her home. LPA verified this request with licensee and verified that the individual no longer lives in the home. LPA reminded licensee that any adults living in the home or present during her hours of operation must have criminal record clearance. LPA advised licensee to report any changes to the Department.

Exit interview was conducted with Licensee Marianela Diaz. A copy of this report was provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2019
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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