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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419516
Report Date: 03/28/2022
Date Signed: 03/28/2022 02:40:59 PM

Document Has Been Signed on 03/28/2022 02:40 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:BAHENA FAMILY CHILD CAREFACILITY NUMBER:
197419516
ADMINISTRATOR:BAHENA, SILVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 433-1177
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
03/28/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Silvia BahenaTIME COMPLETED:
03:00 PM
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An unannounced Case Management inspection was conducted March 28, 2022 at 2:00 pm by the El Segundo Licensing Program Analyst (LPA) Judy Laureano for the purpose ensuring that licensee, Silvia Bahena has ceased operations of her Family Child Care Home at 6307 S. Harcourt Avenue, Los Angeles, CA 90043 as stated in the Stipulation and Waiver and Order- CDSS N. 6321120101.

LPA Laureano reviewed and provided licensee, Silvia Bahena, with a copy of the Stipulation and Waiver and Order- CDSS N. 6321120101.

Per licensee, the last day of care was provided on 3/25/2022. LPA Silvia Bahena guided LPA Laureano on a tour of the home inside and outside and no children were observed on this date.


Exit interview was conducted and a copy of report was provided.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2022
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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