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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195700292
Report Date: 09/13/2024
Date Signed: 09/13/2024 04:11:42 PM

Document Has Been Signed on 09/13/2024 04:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MELGAR CANO FAMILY CHILD CAREFACILITY NUMBER:
195700292
ADMINISTRATOR/
DIRECTOR:		DELFINA MELGAR CANOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 392-0317
CITY:LOS ANGELESSTATE: CAZIP CODE:
90035
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Delfina Melgar Cano, ApplicantTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On today's date, an unannounced Case Management visit was conducted by Licensing Program Analysts (LPA) Silva Garibyan to the residence of Delfina Melgar Cano, Applicant at 1632 South Wooster Street, Los Angeles, CA 90035 to deliver an amended version of the citation page of the report created on 08/09/2024. Upon arrival, LPA met with applicant who assisted with the visit. The citation page of the report was amended to change the Deficiency Type from A to B. Applicant was present with her adult daughter. No children were present at the time of the visit.

Exit interview was conducted and report was given to Delfina Melgar Cano/Applicant.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Silva Garibyan
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
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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