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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419750
Report Date: 08/05/2021
Date Signed: 08/05/2021 09:36:07 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/05/2021 09:36 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:LEWIS FAMILY CHILD CAREFACILITY NUMBER:
197419750
ADMINISTRATOR:LEWIS, MINERVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 406-7991
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
08/05/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:TIME COMPLETED:
09:36 AM
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On 08/05/2021 at 9:05am Licensing Program Analyst (LPA) Laticia Thompson attempted to conduct an Annual Inspection at Lewis Family Child Care Home. LPA called facility phone number to conduct a risk assessment of facility, LPA reached voicemail and left a message. LPA knocked at front door and rung door bell no answer. LPA called phone number located on facility advertisement sign (818) 488- 1909, no answer and voicemail has not been set up. LPA conducted a walk around of facility and did not hear any activity of children or adults.

LPA knocked on neighbors doors no answer.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2021
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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