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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304312024
Report Date:
01/29/2020
Date Signed:
01/29/2020 01:08:38 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
ROJAS, MARIA
FACILITY NUMBER:
304312024
ADMINISTRATOR:
ROJAS, MARIA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(714) 661-2378
CITY:
SANTA ANA
STATE:
CA
ZIP CODE:
92703
CAPACITY:
14
CENSUS:
DATE:
01/29/2020
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:15 AM
MET WITH:
TIME COMPLETED:
11:45 AM
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SUPERVISOR'S NAME:
Judy Hanson
TELEPHONE:
(714) 703-2807
LICENSING EVALUATOR NAME:
Yesenia Villa
TELEPHONE:
(714) 293-9465
LICENSING EVALUATOR SIGNATURE:
DATE:
01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/29/2020
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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