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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503903997
Report Date: 12/09/2021
Date Signed: 12/09/2021 05:05:36 PM

Document Has Been Signed on 12/09/2021 05:05 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:LOPEZ, MONICA FAMILY CHILD CAREFACILITY NUMBER:
503903997
ADMINISTRATOR:LOPEZ, MONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 869-3884
CITY:RIVERBANKSTATE: CAZIP CODE:
95367
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
12/09/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Lopez, MonicaTIME COMPLETED:
05:10 PM
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Regional Manager (RM), Rebecca Varela, Licensing Program Manager (LPM), Alice Juarez, and Licensing Program Analyst (LPA), Roman Iglesias, served licensee, Monica Lopez, with the following Temporary Suspension Order (TSO) documents:

1. Temporary Suspension Order
2. Statement to Respondent
3. Government Code Statutes
4. Summary Instructions for Licensee
5. Summary of Charges
6. Accusation
7. Confidential Names List
8. Request for Discovery
9. Notice of Defense (2)

The above documents have been explained to Mrs. Lopez. Additionally, 12 copies of the parent TSO notification and accusation were left with Mrs. Lopez to provide to parents. The Closed for Business sign was also given to Mrs. Lopez and will be posted on the front door of the Family Child Care Home (FCCH).

Licensee, Monica Lopez, is hereby notified that the operation of the Family Child Care Home (FCCH) shall cease as of December 9, 2021, at 6:00 p.m.

SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Roman Iglesias
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2021
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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