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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494184
Report Date: 04/22/2024
Date Signed: 04/22/2024 11:19:40 AM

Document Has Been Signed on 04/22/2024 11:19 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:NGUYEN FAMILY CHILD CAREFACILITY NUMBER:
197494184
ADMINISTRATOR/
DIRECTOR:		NGUYEN, NATALIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 943-0371
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
04/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Natali Nguyen, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 04/22/2024 at 10:15 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Unusual Incident Report visit at the above address.. LPA identified self and met with Natali Nguyen,Licensee and conducted a tour of the inside and outside of the facility. Upon arrival there were no children or staff present..

During today's visit, LPA observed the facility, toured the facility, interviewed licensee and photographed areas that have water damage.

Licensee stated that the repairs to bedroom #3 ceiling and closet and the kitchen ceiling will be completed by 4/23/2024.

An exit interview was conducted with Natali Nguyen, Licensee and a copy of this report and appeal rights were provided. A Notice of Site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2024
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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