<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198017711
Report Date:
04/04/2023
Date Signed:
05/03/2023 10:09:56 AM
COMPREHENSIVE INSPECTION
Document Has Been Signed on
05/03/2023 10:09 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 CNTR DR. 200-B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
LOPEZ DE RAMIREZ FAMILY CHILD CARE
FACILITY NUMBER:
198017711
ADMINISTRATOR:
LOPEZ DE RAMIREZ, MIRNA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(626) 917-7687
CITY:
LA PUENTE
STATE:
CA
ZIP CODE:
91744
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
04/04/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
03:06 PM
MET WITH:
TIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
SUPERVISORS NAME
:
Ana Chico
LICENSING EVALUATOR NAME
:
Carolyn Tuba
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/04/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1