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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198003208
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:39:11 PM

Document Has Been Signed on 08/16/2023 02:39 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:GREEN FAMILY CHILD CAREFACILITY NUMBER:
198003208
ADMINISTRATOR:GREEN, LA DORISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 871-0695
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:La Doris Green, LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted a Plan of Correction (POC) inspection on this date. LPA met with Licensee, La Doris Green and gave LPA a tour. The purpose of the POC inspection was determine if Licensee has corrected the deficiency cited on 7/18/2023.
LPA determined the following:
  • LPA observed 2 infants and 5 children.
  • LPA did not observe any cleaning products during today's visit.
  • LPA reviewed 3 children's files and did not observed LIC 9224 (Acknowledgment of Receipt) in children's files. Per Licensee, she misunderstood and had parents sign child's file stating that they are aware of the citation.
  • LPA observed Notice of Site visit 07/18/2023 posted in the hallway.
  • LPA did not observe the report, per Licensee did not understand the process.
During today's visit, LPA explained the citation process and printed out the report from 07/18/23 and LIC 9224 (Acknowledgment of Receipt). A copy of the report from 07/18/23 shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of the report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt.

Although Licensee was missing signatures on the LIC 9224 and the report, LPA will clear citation since LPA did not observe cleaning compounds at the facility. A referral for the department Technical Support Program will be made to help ensure the safety of children in care.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Licensee Green, but not limited to Provider Rights, Appeal Rights were given in and explained.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2023
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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