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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 02/29/2024
Date Signed: 02/29/2024 09:10:02 AM

Document Has Been Signed on 02/29/2024 09:10 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: 6CENSUS: 2DATE:
02/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Licensee Concepcion Ruiz TIME COMPLETED:
09:15 AM
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THIS INSPECTION WAS CONDUCTED IN SPANISH
Licensing Program Analyst (LPA) Jeanette Estrada conducted an unannounced Case Management visit for the purpose of delivering the amended Facility Evaluation Report LIC 809 dated 2/26/24. LPA met with Licensee Concepcion Ruiz and explained the reason for the visit. LPA observed 2 children in care. Licensee was observed to be the only adult present in the home during the visit.

LPA J. Estrada reviewed amended report with Licensee and explained the reason for the amendment was due to a discrepancy with the date typed on the LIC 809 by LPA J. Estrada. On the original report, LPA typed 2/26/29 instead of the correct date of 2/26/24.

The Licensee signed the amended report and LPA provided a copy of the amended report to the Licensee.

The Notice of Site Visit (LIC 9213 ) was provided to the Licensee. The Notice of Site Visit must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Licensee Concepcion Ruiz and a copy of this report was provided.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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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