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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020309
Report Date: 04/11/2022
Date Signed: 04/11/2022 01:47:10 PM


Document Has Been Signed on 04/11/2022 01:47 PM - 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:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
198020309
ADMINISTRATOR:ADRIANA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 604-9664
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:14CENSUS: 9DATE:
04/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Adriana Lopez, LicenseeTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Alicia Mooberry arrived at the above facility at 1:09pm to conduct a Case Management inspection regarding an incident that was reported by the licensee on 04/01/2022 regards a biting incident involving Child #1 and Child #2. The Monterey Park South West Child Care Regional Office received the incident report on 4/01/2021. There were 9 napping children and 3 adults present upon arrival. All adults have obtained background clearance and are associated.

LPA toured the facility indoor and outdoor. Files review were conducted, and child's document obtained. On the day of the incident, there were three staff supervised 10 children. Based on the information that were gathered during today's interviews, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was cited.

The content of this report was read and discussed in detail with the noted person.

An exit interview was conducted with licensee Adriana Lopez
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2022
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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