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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495103
Report Date: 08/02/2022
Date Signed: 08/02/2022 10:50:46 AM

Document Has Been Signed on 08/02/2022 10:50 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CASTILLO FAMILY CHILD CAREFACILITY NUMBER:
197495103
ADMINISTRATOR:IRMA CASTILLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 841-0852
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
08/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Irma CastilloTIME COMPLETED:
11:00 AM
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On 8/2/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Case Management – Other inspection as part of frequent monitoring per the non-compliance conference held on 6/10/2022.

LPA is also obtaining signature from the Licensee on the amended LIC 809 report issued on 6/27/2022 and providing a copy to the Licensee of the Cleared Plan of Correction Letter for the Type A deficiency issued on 6/10/2022. LPA met with Licensee, Irma Castillo, who toured LPA through the indoor and outdoor of the facility. LPA observed 6 children and 2 adults (cleared and associated).

During today’s visit, LPA observed the following items posted on the parent board: LIC 9099, LIC 9099C, LIC 9099D and Notice of Site Visit issued on 7/13/2022. LPA reviewed LIC 9227 forms signed by parents/authorized representatives in each child’s file.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations. An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Licensee, Irma Castillo. This inspection was conducted in Spanish.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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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