Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192002652
Report Date: 06/22/2017
Date Signed 08/25/2017 03:15:45 PM

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:TORRES FAMILY CHILD CAREFACILITY NUMBER:
192002652
ADMINISTRATOR:ROSA TORRESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 404-5219
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:14CENSUS: 0DATE:
06/22/2017
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Brenda AlcivarTIME COMPLETED:
12:07 PM
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This is an amended report to indicate that this report was created in error and does not apply to the Facility above.

An unannounced Annual Random Inspection was conducted by Licensing Program Analyst (LPA) Raul Navarro.

Upon arrival LPA met with Licensee Brenda Alcivar. Licensee stated to LPA that she is no longer taking care of children and has not taken care of children for a period of time due to illness. Licensee stated she no longer is interested in having a child care license and would like to close her facility at this moment.

Licensee Brenda Alcivar submitted a statement surrendering her License, and provided her license to LPA.

Licensee understands that she is surrendering her license and stated that she will not take care of children.

Licensee understands that in the future, she may reapply for a License with the Department.

SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2017
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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