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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314163
Report Date: 12/08/2023
Date Signed: 12/08/2023 01:20:58 PM

Document Has Been Signed on 12/08/2023 01:20 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:MONTANO, EMILIAFACILITY NUMBER:
304314163
ADMINISTRATOR:MONTANO, EMILIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 848-7840
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
12/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Licensee Emilia MontanoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) R. Castanon conducted an unannounced case management visit. Upon arrival, LPA met with Licensee Emilia Montano. Observed at the time of the visit was a total of 6 children and 1 assistant.

A review of the Facility Personnel Report Summary on 12/08/2023 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.



LPA explained the reason for today’s visit to Licensee Emilia Montano. The licensing department's report system does not reflect forms provided to Licensee during previous visits conducted on 09/15/2023 and 10/09/2023. LPA provided Licensee with copies of LIC9058 Appeal Rights on this day for those visits.

Exit interview was conducted with Licensee Emilia Montano.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Romelia M Castanon
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2023
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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