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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700150
Report Date: 07/20/2023
Date Signed: 07/20/2023 09:39:13 AM

Document Has Been Signed on 07/20/2023 09:39 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FLORES FAMILY CHILDCAREFACILITY NUMBER:
195700150
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/20/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Nacy Flores- LicenseeTIME COMPLETED:
09:55 AM
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On 07/20/2023, Licensing Program Analyst's (LPA) Suzette Ornelas conducted an announced case management inspection for the purpose of amending a report and obtaining LIC279.

Upon arrival LPA was greeted by Licensee, Nancy Flores and observed 0 children in care.

During todays visit, LPA amended a report and obtained signatures.

Exit interview was conducted. Notice of Site Visit provided.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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