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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000024
Report Date: 09/23/2021
Date Signed: 09/23/2021 11:27:54 AM

Document Has Been Signed on 09/23/2021 11:27 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:LARA FAMILY CHILD CAREFACILITY NUMBER:
192000024
ADMINISTRATOR:ROSA LARAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 728-0088
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
09/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:LIcensee - Rosa LaraTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) R. Derraco attempted to conduct an annual inspection to the above mentioned facility on 09/23/21. LPA observed 5 children in care and 4 adults (including licensee). LPA observed the home to be clean and in good repair. Licensee states that 4 of the children are her grand children and the other child is a friend's child. Licensee states that 2 of her grand children belong to her daughter (S2), who was also present during the inspection. Licensee states that the other two grand children belong to her son. Licensee states she does not receive any income for watching the children. Licensee states that she no longer want to provide child care services and would like to close her license. LPA advised licensee to draft a letter indicating intention to close her license and sign letter. LPA reminded licensee of regulations regarding exemption to licensed care (Title 22, Division 12, Chapter 1, Article 2 Section 102358). LPA observed that licensee is in compliance with said regulation at this time. Licensee provided LPA a hand written letter indicating date of closure to be September 23, 2021.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2021
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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