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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013810
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:11:17 PM

Document Has Been Signed on 06/16/2022 01:11 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:JAUREQUI FAMILY CHILD CAREFACILITY NUMBER:
198013810
ADMINISTRATOR:JAUREQUI, MIRNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 964-3957
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 12DATE:
06/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mirna JaurequiTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Elka Chavez conducted an unannounced case management other inspection in Spanish. Upon arrival LPA Chavez met with Licensee, Mirna Jaurequi.

The purpose of the inspection was to obtain additional information regarding an incident.

During the inspection, LPA Chavez interviewed staff and children.

There were no deficiencies cited during today's inspection.

The notice of site inspection must remain posted for 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Licensee, Mirna Jaurequi.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Elka Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/16/2022
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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