<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314174
Report Date: 08/09/2023
Date Signed: 09/15/2023 10:51:58 AM

Document Has Been Signed on 09/15/2023 10:51 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:HERRERA CAMACHO, ELIANAFACILITY NUMBER:
304314174
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/09/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Eliana Herrea Camcho, ApplicantTIME COMPLETED:
10:03 AM
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
Licensing Program Analyst (LPA) Tran conducted a scheduled visit with the applicant and Adult #1 in the home to interview Applicant and Adult #1 regarding issues with the previous license # 304312749.

During the visit, LPA gathered information regarding the revocation of the previous license, the reasons for applicant failed to comply with Title 22 Regulations with the previous license, and applicant's plan to ensure compliancy with the Child Care Regulations and Health and Safety Code when applying for the new license.

Applicant and Adult #1 stated that they would submit 3 references letters to the LPA by 08/18/2023.

LPA explained the importance of being honest and complying with all necessary requirements to the Department. Applicant and Adult #1 acknowledged it.

(End of Report)
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Nguyen K Tran
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2023
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