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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806442
Report Date: 03/21/2022
Date Signed: 03/21/2022 11:35:57 AM

Document Has Been Signed on 03/21/2022 11:35 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHAVEZ FAMILY CHILD CAREFACILITY NUMBER:
191806442
ADMINISTRATOR:CHAVEZ, APOLONIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 262-6934
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 12TOTAL ENROLLED CHILDREN: 2CENSUS: 0DATE:
03/21/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Apolonia Chavez TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced inspection on 03/21/22 at approximately 10:55 AM to determine if the facility is operating. This inspection was conducted in Spanish. LPA met with Licensee, Apolonia Chavez. Licensee states she is currently active. There are 2 children enrolled who are school age children.

LPA provided Licensee with stipend information and assistance with registration.

LPA provided information for annual inspection which will be conducted at a later date.

Email and phone numbers verified.

Exit interview conducted with Apolonia Chavez.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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