<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011139
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:51:10 PM

Document Has Been Signed on 10/04/2024 03:51 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MATEOS FAMILY CHILD CAREFACILITY NUMBER:
198011139
ADMINISTRATOR/
DIRECTOR:		MATEOS, LUCILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 752-3914
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/04/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Lucila Mateos, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Franchesca White arrived at the above facility for the purpose of an unannounced Case Management Legal/Non-Compliance visit. LPA White announced the purpose of the visit and was granted entry into the facility. There were 8 children present at the time of visit. All staff have current criminal clearance. All residence in the home were discussed.

The purpose of today's visit is to deliver the signed documentation of the Non-Compliance meeting held on Tuesday, June 11, 2024. LPA White ensured Licensee understood the details of the report.

A Notice of Site visit was given, and must be posted for 30 days.

LPA reviewed report, provided a copy of report and appeal rights (In English and Spanish) given to Licensee Lucila Mateos.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1