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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402475
Report Date: 08/24/2022
Date Signed: 08/24/2022 10:51:18 AM


Document Has Been Signed on 08/24/2022 10:51 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:GILL FAMILY DAY CAREFACILITY NUMBER:
197402475
ADMINISTRATOR:GILL, CATHY D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 758-6762
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 0DATE:
08/24/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Cathy GillTIME COMPLETED:
10:45 AM
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On 8/24/22, Licensing Program Analyst (LPA), V.Wheatley met with the licensee Cathy Gill at 9:30am to have the license review and sign the report from previous inspection on 8/11/22. LPA had computer issues. LPA also reviewed paperwork to add the licensee's daughter to the license.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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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