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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198017794
Report Date:
07/08/2022
Date Signed:
07/08/2022 03:30:55 PM
Document Has Been Signed on
07/08/2022 03:30 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 CNTR DR. 200-B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
OPTIONS HEAD START/CDC - MEMORIAL PARK
FACILITY NUMBER:
198017794
ADMINISTRATOR:
LAURA ANGUIANO
FACILITY TYPE:
850
ADDRESS:
328 N. ORANGE AVE.
TELEPHONE:
(626) 967-7848
CITY:
AZUSA
STATE:
CA
ZIP CODE:
91702
CAPACITY:
135
TOTAL ENROLLED CHILDREN:
135
CENSUS:
DATE:
07/08/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
08:44 AM
MET WITH:
TIME COMPLETED:
09:00 AM
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LPA arrived approximately 8:30 AM to conduct an unannounced Annual Site Inpspection and found the facility to be closed. LPA called the number listed on the gate but was unable to reach anyone.
SUPERVISORS NAME
:
Ana Chico
LICENSING EVALUATOR NAME
:
Bardo Baluyot
LICENSING EVALUATOR SIGNATURE
:
DATE:
07/08/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/08/2022
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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