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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198018823
Report Date:
03/03/2022
Date Signed:
03/03/2022 12:00:30 PM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
03/03/2022 12:00 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
,
1000 CORPORATE CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
O'SULLIVAN FAMILY CHILD CARE
FACILITY NUMBER:
198018823
ADMINISTRATOR:
O'SULLIVAN, KRISTEN
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(714) 932-1864
CITY:
LONG BEACH
STATE:
CA
ZIP CODE:
90804
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
DATE:
03/03/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:15 AM
MET WITH:
TIME COMPLETED:
09:30 AM
NARRATIVE
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attempted visit
SUPERVISORS NAME
:
Valarie Cook
LICENSING EVALUATOR NAME
:
Dayna Chambers
LICENSING EVALUATOR SIGNATURE
:
DATE:
03/03/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/03/2022
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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