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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198014640
Report Date:
10/23/2024
Date Signed:
10/23/2024 11:55:34 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
10/23/2024 11:55 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
CCLD Regional Office
,
1000 CORPORATE CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
JIMENEZ FAMILY CHILD CARE
FACILITY NUMBER:
198014640
ADMINISTRATOR/
DIRECTOR:
JIMENEZ, ANGELICA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(562) 912-4151
CITY:
LONG BEACH
STATE:
CA
ZIP CODE:
90806
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
5
DATE:
10/23/2024
TYPE OF VISIT:
Annual/Random
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:
Angelica Jimenez,
TIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Due to time constraints, LPA will continue the inspection at a later time; unable to complete inspection due to time constraints -
SUPERVISORS NAME
:
Valarie Cook
LICENSING EVALUATOR NAME
:
Dayna Chambers
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/23/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/23/2024
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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