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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403631
Report Date: 04/05/2023
Date Signed: 04/05/2023 10:26:50 AM


Document Has Been Signed on 04/05/2023 10:26 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:WOODS FAMILY DAY CAREFACILITY NUMBER:
197403631
ADMINISTRATOR:LAFREDA WOODSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 291-0704
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:14CENSUS: 0DATE:
04/05/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:LaFreda Woods, LicenseeTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced case management inspection due to deficiency observed. LPA met with Licensee, LaFreda Woods. There were no children present during inspection.

During an inspection, LPA determined during file review that the facility roster (LIC 9040) did not have current parent contact information. This poses a potential risk to the health and safety of children in care. The facility is cited a "B" violation on this date in accordance with California Code of Regulations Title 22. The licensee provided an updated copy of the facility roster on this date.

Exit interview conducted with Licensee, LaFreda Woods. Appeal Rights provided. The Notice of Site Visit and report was issued. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/05/2023 10:26 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: WOODS FAMILY DAY CARE
FACILITY NUMBER: 197403631

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/05/2023
Section Cited

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Each family child care home shall have a current roster of children... The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
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The licensee provided an updated roster on this date. Deficiency corrected during inspection
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This requirement is not met as evidenced by: The Children's roster provided to LPA on 1/12/23 did not have the correct phone numbers for 4 out of 5 children in care. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/05/2023
LIC809 (FAS) - (06/04)
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