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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503903997
Report Date: 05/09/2022
Date Signed: 05/09/2022 04:53:02 PM

Document Has Been Signed on 05/09/2022 04:53 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:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 0TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
05/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Monica LopezTIME COMPLETED:
12:45 PM
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On May 9, 2022, Licensing Program Analyst's (LPA's) Priscilla Zamudio and Angelica Slaughter completed an unannounced case management visit to the home of Monica Lopez. The purpose of this visit is to confirm the facility is closed and no longer operating.

LPA’s met with Ms. Lopez and confirmed that she received the Default Decision and Order and is not operating the family child care home. At the time of the visit, LPA's observed two children and Ms. Lopez stated they were her grandchildren.

LPA's left an additional copy of the Decision and Order with Ms. Lopez.

Ms. Lopez refused to sign this report, therefore, a copy was not provided.

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Priscilla Zamudio
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2022
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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