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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415094
Report Date: 10/02/2019
Date Signed: 10/03/2019 11:10:56 AM

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:CHAPPELL FAMILY CHILD CAREFACILITY NUMBER:
197415094
ADMINISTRATOR:CHAPPELL, RAYSHAUNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 973-8064
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 5DATE:
10/02/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Rayshaun Chappell, LicenseeTIME COMPLETED:
04:12 PM
NARRATIVE
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Licensing Program Analyst (LPA), Shandra Powell conducted a Case Management- Deficiencies visit during a Complaint investigation. Upon arrival LPA was greeted by assistant Wanda Jackson. LPA was given a tour of the home. 5 children were present during inspection with 1 staff. Five minutes into the inspection staff #2 entered home.

LPA observed one infant child sleeping in a car seat and one child sleeping in a booster/floor seat during inspection. The following is being cited in accordance to Title 22 of the California Code of Regulations. Please refer to 809D for cited deficiencies

This poses an immediate risk to the health and safety of children in care.

.A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the Licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Rayshaun Chapppell, Licensee, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHAPPELL FAMILY CHILD CARE
FACILITY NUMBER: 197415094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2019
Section Cited

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Personal Rights
To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
**This requirement is not met as
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evidenced by LPA observing Child#1 sleeping in a car seat on floor in Master Kitchen, Child#2 sleeping in booster chair on floor in Master Kitchen. This poses an immediate health and safety risk to the 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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:
DATE: 10/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/03/2019
LIC809 (FAS) - (06/04)
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