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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412359
Report Date: 06/23/2022
Date Signed: 01/05/2024 10:39:49 AM

Document Has Been Signed on 01/05/2024 10:39 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:GASTON FAMILY CHILD CAREFACILITY NUMBER:
197412359
ADMINISTRATOR:GASTON, NELLY & GASTON, R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 904-1619
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
06/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Rosario Gaston and Nelly Gaston TIME COMPLETED:
10:45 AM
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On 6/23/2022 Licensing Program Analyst (LPA), Judy Laureano conducted an unannounced case management inspection to deliver and review amended report. LPA reviewed amended report with Rosario Gaston Original LIC8099 was generated on 4/28/2022.

LPA observed 3 children and 2 staff member.

Exit interview conducted and report was reviewed with the licensee Rosario Gaston. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2022
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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