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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197415094
Report Date: 10/03/2019
Date Signed: 10/03/2019 11:36:28 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:
10/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Rayshaun Chappell, LicenseeTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPA) Shandra Powell conducted an unannounced case management inspection. LPA was greeted by worker Wanda Jackson. Licensee was not present at the initial start of the visit. Licensee joined the visit approximately 30 minutes after LPA arrived. Licensee gave LPA a tour of the home. This is a single dwelling 3 bedroom 2 bathroom home which consist of a 2 kitchens, living room, dinning room, backyard and garage. Master Bed Room #3 has a Jacuzzi Tub. Room is Off Limits door was locked during visit. LPA did observe cleaning compounds in room #2 on floor (door closed but unlocked). LPA advised license to move all cleaning compounds behind a locked door or cabinet. Licensee moved all compounds to master bedroom and locked door. 3 children were present with 1 staff at the initial start of visit. 5 children were present with 2 staff at the end of the visit.

The purpose of the visit was to inspect the facility to ensure the health and safety of children in care and to deliver original reports to licensee from inspection on 10/02/2019.

There were no deficiencies cited during today's visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made 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 Chappell, Licensee, including, but not limited to Appeal Rights and Agency's consultative role.
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 licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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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