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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013828
Report Date: 11/30/2023
Date Signed: 11/30/2023 01:12:03 PM

Document Has Been Signed on 11/30/2023 01:12 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KHER FAMILY CHILD CAREFACILITY NUMBER:
198013828
ADMINISTRATOR:MITA J KHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 402-9650
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mita KherTIME COMPLETED:
01:30 PM
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An unannounced case management visit was conducted today by Licensing Program Analyst (LPA), T. Tran at the above licensed home. Upon arrival, LPA met with licensee, Mita Kher and observed no children in care.

The purpose of today’s visit is to follow up on the overdue inactive status of the license. During today's visit, licensee stated she no longer wishes to operate her childcare license. LPA obtained the surrender license letter request and the original license for the record.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee, Mita Kher.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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