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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402545
Report Date: 06/30/2022
Date Signed: 06/30/2022 02:21:55 PM

Document Has Been Signed on 06/30/2022 02:21 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LOPEZ FAMILY DAY CAREFACILITY NUMBER:
197402545
ADMINISTRATOR:LOPEZ,MARITZA &JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 893-8457
CITY:NORTH HILLSSTATE: CAZIP CODE:
91343
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
06/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Maritiza Licensee and Jose Lopez, Co-LicenseeTIME COMPLETED:
02:30 PM
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On 6/30/2022 at 12:50PM, Licensing Program Analyst (LPA), Denise Miranda conducted an unannounced Annual Required Inspection and was met by Licensee, Maritza Lopez and Jose Lopez, Co-Licensee. Also present was Licensee’s daughter with her two children, that per licensee and co-licensee, all living at this address. LPA observed two additional children that who two are infants. Per licensee and co-licensee, the two additional children residing at this location with their son and daughter as well. Licensee and Co-licensee provided proof of this children were family member. This inspection was conduct in Spanish. LPA toured the home inside and outside. During this inspection, Licensee and Co-licensee made the payment of the overdue amount of $140.00. Per Licensee and Co-licensee requested, LPA provided consultation, how to access the website (www.ccld.ca.gov) to make a payment of overdue fee and a copy of fee payment was provided to LPA.

Per Licensee and Co-Licensee were no able to locate the original license certificate, declaration (form LIC855) signed by Licensee and Co-licensee and copy of their current driver license was obtained during this inspection. As of today, Licensee and Co-licensee requested to surrender the Family Child Care License.

Per Licensee and Co-licensee, there are 5 children that residing on this house, an updated LIC279B was provided by Licensee and Co-licensee.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days. Exit interview conducted and report was reviewed with the Licensee and Co-licensee.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2022
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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