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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314416
Report Date: 08/22/2024
Date Signed: 08/22/2024 10:15:32 AM

Document Has Been Signed on 08/22/2024 10:15 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ORTIZ CUESTAS, THALIAFACILITY NUMBER:
304314416
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/22/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Thalia Ortiz CuestasTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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On 8/22/2024, Licensing Program Analysts (LPAs) Silva conducted an announced Case Management – Other visit. The LPA met with applicant Thalia Ortiz Cuestas who was informed of the purpose of the visit. A review of the Facility Personnel Report Summary indicates two adults live in the home.

During the visit, the LPA conducted interviews and obtained documents relevant to the reason for the visit.

An exit interview was conducted.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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