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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411153
Report Date: 09/28/2021
Date Signed: 09/28/2021 01:24:37 PM

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:JOHNSON FAMILY CHILD CAREFACILITY NUMBER:
197411153
ADMINISTRATOR:JOHNSON, LA TRICIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 753-4453
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:14CENSUS: DATE:
09/28/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:La Tricia JohnsonTIME COMPLETED:
01:36 PM
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On 09/28/2021 Licensing Program Analyst (LPA) met with licensee, La Tricia Johnson today for the purpose of conducting a Plan of Correction inspection. During the unannounced inspection, LPA observed 2 children in care, one assistant (Cheyna Rozelle) and licensee father James Johnson. All adults have been cleared per review of LIS associate list. The following corrections were observed:

LPA reviewed 5 Children Files that were complete with all required documents

Licensee father was in the process of replacing facility poster board. Licensee was provided a list of required documentation to be posted. Licensee was unable to print out updated facility roster. Licensee will email a copy of facility roster to LPA by the COB today. Licensee will view videos from POC by 10/05/2021 and provide proof of completion by COB on 10/05/2021.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021
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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