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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198003615
Report Date:
03/10/2023
Date Signed:
03/13/2023 10:16:52 PM
Document Has Been Signed on
03/13/2023 10:16 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:
CHAVEZ FAMILY CHILD CARE
FACILITY NUMBER:
198003615
ADMINISTRATOR:
CHAVEZ, MARIA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(562) 621-0730
CITY:
LONG BEACH
STATE:
CA
ZIP CODE:
90804
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
5
DATE:
03/10/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
02:15 PM
MET WITH:
Maria Chavez, Licensee
TIME COMPLETED:
04:45 PM
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SUPERVISORS NAME
:
Valarie Cook
LICENSING EVALUATOR NAME
:
Dayna Chambers
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/10/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/10/2023
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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