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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494582
Report Date: 11/07/2022
Date Signed: 11/07/2022 01:28:13 PM

Document Has Been Signed on 11/07/2022 01:28 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:AMZALEG FAMILY CHILD CAREFACILITY NUMBER:
197494582
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Moran AmzalegTIME COMPLETED:
11:45 PM
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On 11/07/2022, Licensing Program Analyst (LPA) Judy Laureano, conducted a case management inspection for the purpose of ensuring the standards for a Family Child Care Home are being met in accordance to California Tittle 22 Regulations and California Health and Safety Codes.

At 11:00 a.m., LPA was greeted by assistant and housekeeper. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home.

The following was observed: 6 children with one staff member, Esther Admka-assistant, in the day care room. Notice of Site visit along with report dated 10/27/2022 was posted and made available to all parents.

Licensee was not in facility when LPA arrived. Assistant called licensee and licensee arrived at 11:10 am.

An exit interview was conducted, a copy of this report and notice of site visit was provided licensee, Moran Amzaleg.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2022
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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