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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416878
Report Date: 08/18/2023
Date Signed: 08/18/2023 02:25:20 PM


Document Has Been Signed on 08/18/2023 02:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:MINWALLA FAMILY CHILD CAREFACILITY NUMBER:
197416878
ADMINISTRATOR:MINWALLA, SHAMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 801-8155
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:14CENSUS: 6DATE:
08/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Shama MinwallaTIME COMPLETED:
02:30 PM
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On 8/18/2023 Licensing Program Analyst (LPA) Judy Laureano arrived conducted an unannounced case management inspection to deliver and review amended report. LPA reviewed amended report with Shama Minwalla. Original LIC 9099 was generated on 8/15/2023.

LPA observed 6 children and 1 staff member.

Exit interview conducted and report was reviewed with the licensee Shama Minwalla. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: 424-301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/18/2023
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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