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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191605400
Report Date: 05/30/2023
Date Signed: 05/30/2023 08:54:18 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/30/2023 08:54 AM - 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:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
191605400
ADMINISTRATOR:GRACE, ANDREW AND WANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 323-0766
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 0DATE:
05/30/2023
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Grace Davis, LicenseeTIME COMPLETED:
09:15 AM
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LPA Chambers arrived at the home for an inspection. The licensee is not ready to open for business and requested if she could go on inactive status. LPA Chambers provided licensee with the inactive form. The licensee filled out the form. LPA answered various questions.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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