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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609404
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:50:17 AM

Document Has Been Signed on 09/05/2024 11:50 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RUIZ-CHAVARIN FAMILY CHILD CAREFACILITY NUMBER:
191609404
ADMINISTRATOR/
DIRECTOR:		CONCEPCION RUIZ CH.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(424) 406-2106
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:05 AM
MET WITH:CONCEPCION RUIZ CHAVARIN / LICENSEETIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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 THIS INSPECTION WAS CONDUCTED IN SPANISH
Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced case management visit. LPA was greeted by Licensee Concepcion Ruiz Chavarin who allowed LPA entry to the facility.

LPA observed no children in care. Licensee provided a tour of the facility in on/ off limit area to ensure no children are present. LPA observed to have no toy and equipment for children.

Per Licensee, wrote a letter and submitted to Department surrendering her licensee about 3 months ago, how ever letter was not received.

Therefore, LPA collected Facility License and written letter statement surrendering licensee.

Per Licensee, closed as since June 15, 2024.

An exit interview was conducted with Licensee Concepcion Ruiz Chavarin.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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