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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400117
Report Date: 03/23/2022
Date Signed: 03/23/2022 03:51:16 PM

Document Has Been Signed on 03/23/2022 03:51 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:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
198400117
ADMINISTRATOR:TERESA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 872-4112
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 6DATE:
03/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
03:16 PM
MET WITH:Teresa PerezTIME COMPLETED:
04:05 PM
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Licensing Program Analyst (LPA) conducted a Case Management inspection on 03/23/2022 at 3:16pm for the purpose of inspecting a new area of the home. There was a total of six children with two adults present.

Licensee is requesting to use the garage as an additional activity space. All areas identified on the updated facility sketch that are accessible for children to use were inspected for safety, comfort, and cleanliness.

Based on LPA's observations the garage is safe for the children to use. LPA reminded the Licensee that the garage is only to be used as an activity space. Licensee understands that the children cannot eat or sleep in the garage.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Teresa Perez.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Raul Navarro
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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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