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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400515
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:13:24 PM

Document Has Been Signed on 07/18/2024 03:13 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:PRIETO FAMILY CHILD CAREFACILITY NUMBER:
198400515
ADMINISTRATOR/
DIRECTOR:		PRIETO, MIRSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 219-2506
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Mirsa PrietoTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 7/18/2024 at 2:00 p.m. Licensing Program Analyst Claudia Kam conducted a Case Management incident inspection at the above facility to follow up on and incident that was not reported to the department.

LPA completed record review and interviews were conducted. Based on the information that was available
it was observed that licensee completed the unusual incident report and reported to the department. The report was viewed along with the sent email to the department, as verification that she did submit and report timely. LPA has provided the licensee with the incident report email and unusual incident report form.

No deficiency was cited at this time.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the facility representative, Mirsa Prieto.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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