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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 12/21/2023
Date Signed: 12/21/2023 09:52:27 AM

Document Has Been Signed on 12/21/2023 09:52 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:RUIZ-CHAVARIN FAMILY CHILD CAREFACILITY NUMBER:
191609404
ADMINISTRATOR:CONCEPCION RUIZ CH.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 406-2106
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 12TOTAL ENROLLED CHILDREN: 7CENSUS: 0DATE:
12/21/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Concepcion Ruiz TIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced case management visit for the purpose of confirming that excluded individual, Jesus Sanchez, is no longer residing in the home. LPA met with Licensee, Concepcion Ruiz and explained the reason for the visit. Licensee provided a tour of the facility. There were no children in care during today's visit.

Per Licensee, excluded individual has moved out of the home and is residing elsewhere. Per Licensee, excluded individual has not returned to the home. Licensee has provided the excluded individual’s new address. LPA inspected excluded individual’s bedroom. LPA observed the bedroom to be empty except for a few items such as a couch, a couple of clothing items in the closet and a bed frame. Per Licensee, the couch belongs to her and the other items will be removed during the weekend. LPA did not observe any other personal items in the bedroom or in the bathroom attached to the bedroom. During today’s visit, excluded individual was not observed in the home.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Licensee Concepcion Ruiz-Chavarin. Appeal rights were explained and provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
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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