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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014088
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:31:12 PM

Document Has Been Signed on 05/01/2024 03:31 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SHACK FAMILY CHILD CAREFACILITY NUMBER:
198014088
ADMINISTRATOR/
DIRECTOR:		SHACK, FELICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 639-3443
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Felicia Shack / LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPAs) Ashley Calderon and Susann Sanchez conducted an unannounced inspection at the facility noted above and met with Licensee Felicia Shack. The purpose of the inspection was to conduct an unannounced annual inspection. During time of visit licensee informed LPA's there are no children enrolled and remains active for enrollment. Per Licensee she hasn't had a child enrolled since before COVID. The operating hours of the facility is: Monday through Friday from 7:00 AM to 6:00 PM.

This is a two-story home which consists of 4 bedrooms, 4 bathrooms, kitchen, dining room, living room, office, preschool room, backyard, garage and front yard. The children use the bathroom that is connected to the pre-school room. Per licensee, areas off limits include: all upstairs, all bedrooms, garage, kitchen, dining room, living room , and 3 restroom and front yard. The licensee provides food for children when in care. Individuals residing in the home were discussed and noted. Per licensee, there are no weapons and firearms. Outdoor area is fenced and LPA's did not observe any bodies of water on the premises.

The following documents were posted in a prominent, publicly accessible area: Facility License, Notification of Parents' Rights (PUB 394), and Facility Roster (LIC 9040). Licensee has an Emergency Disaster Plan (LIC 610A) available for review. Licensee was advised that Disaster and Fire Drills must be conducted at least once every six months, and the Licensee shall document the date and time of each drill for review.

Areas used by children were inspected for safety, comfort, heating, cleanliness and telephone service. The home does not have any wall heaters and a fireplace is located in the off limit area inaccessible to the children in care. The home is equipped with central air and heating. Detergents and cleaning compounds are made inaccessible to children. Per Licensee, there are no poisons kept in the home. Licensee was advised that if any poisons are purchased, it is required to be locked.

(Page 1- LIC 809-C-Continuation...)
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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