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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405385
Report Date: 10/17/2022
Date Signed: 10/17/2022 04:10:44 PM

Document Has Been Signed on 10/17/2022 04:10 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:EDWARDS FAMILY CHILD CAREFACILITY NUMBER:
197405385
ADMINISTRATOR:EUNICE EDWARDSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 613-1783
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee, Eunice Edwars TIME COMPLETED:
04:15 PM
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On 10/17/2022 at 10:00am Licensing Program Analyst (LPA) Dalicia Adkins conducted an unannounced case management visit. LPA met with licensee Eunice Edwards, LPA explained the purpose of the visit and was granted entry into the facility. LPA was guided on a tour of the home. There were four children present during this visit.

During case management provided technical assistance and discussed reporting requirements with licensee. 102416. 2 Reporting Requirements. The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm).

Technical Violation (TA) refer to TA LIC 9102TA. Licensee stated that she will adhere to licensing reporting requirements.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources and Guardian resources.

Per Title 22 of the California Code of Regulations, no deficiencies are cited.
Exit interview conducted , copy of this report provided and reviewed with licensee.

LIC 9213 Notice of Site Visit provided and required to be posted for 30 days
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Dalicia Adkins
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2022
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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