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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603000
Report Date: 01/05/2022
Date Signed: 01/05/2022 10:21:54 AM

Document Has Been Signed on 01/05/2022 10:21 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:MEHL FAMILY CHILD CAREFACILITY NUMBER:
191603000
ADMINISTRATOR:MEHL, MARILYN & PAULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 428-8656
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
01/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensees - Paul and Marilyn MehlTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Randy Derraco conducted a case management visit to the above mentioned facility on 01/05/22. LPA met with licensees Marily and Paul Mehl. During visit licensee states she does not have any children currently enrolled. LPA did not observe any children present during visit. Licensee states she would like to go on inactive status from 01/05/22 to 12/31/22 due to health concerns. LPA provided LIC 9211 to licensees. Licensees completed form LIC 9211 during visit.

Case management report was reviewed with licensee.

An exit interview was conducted with licensees Marilyn and Paul Mehl.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2022
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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