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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494075
Report Date: 03/11/2022
Date Signed: 03/11/2022 09:15:48 AM

Document Has Been Signed on 03/11/2022 09:15 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:CARRILLO FAMILY CHILD CAREFACILITY NUMBER:
197494075
ADMINISTRATOR:CARRILLO, MARIA ELIZABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 453-4057
CITY:LOS ANGELESSTATE: CAZIP CODE:
90001
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
03/11/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee Maria CarrilloTIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced Case Management Legal/Non-compliance inspection to this facility for the purpose of reviewing the Decision and Order - Legal Case Number 6221102101-C. LPA met with licensee, Maria Elizabeth Carrillo. Present today at the facility is licensee Maria Carrillo.

LPA asked the licensee if she has received the Decision and Order dated 03/04/22. Licensee states no. LPA provided a copy of Decision and Order dated 03/04/22. The order was discussed with the licensee. Decision and Order states that the revocation of the license regulated by the Department and revocation of Foster Care license excluding licensee, Maria Carrillo, for two years from 03/04/22 from all facilities licensed by the Department. Licensee understands that she has a lifetime exclusion from facilities licensed by the Department and from resource family homes unless she successfully petitions for reinstatement one (1) year from the effective date of this order.

Licensee shall abide by the terms of the order and maintain strict compliance to the Title 22 Code of Regulations and the California Health and Safety Codes.

Exit Interview conducted with licensee. Web site address to obtain forms, review quarterly updates, review Title 22 & Health & Safety Codes is: www.ccld.ca.gov
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2022
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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