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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493570
Report Date: 10/27/2020
Date Signed: 10/27/2020 04:31:40 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:MORRIS FAMILY CHILD CAREFACILITY NUMBER:
197493570
ADMINISTRATOR:AFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(213) 949-0648
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY:14CENSUS: DATE:
10/27/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Shaprae MorrisTIME COMPLETED:
04:30 PM
NARRATIVE
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On 10/27/2020 4:11 pm Licensing Program Analyst (LPAs), Laticia Thompson conducted a Case management deficiency visit during an initial complaint investigation # 30-CC-20200803111927. During the initial investigation LPA observed the following deficiency:

During the complainant investigation, licensee stated that police arrived to her house to interview child#1 prior to the complaint being placed. Until present date, Licensee did not report this incident to El Segundo Regional Office, LPA advised licensee to submit the form LIC624 Unusual Incident Report to El Segundo Regional Office.

Please see LIC809D.

An exit interview was conducted. This report along with a copy of the appeal rights will be sent to the Shaprae Morris, via email and regular mail, licensee will reply to email acknowledging documents were received

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020
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: MORRIS FAMILY CHILD CARE
FACILITY NUMBER: 197493570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2020
Section Cited

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102416.2 Reporting Requirements
(b) The licensee shall report to the Department any of the events as specified in Health and Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.


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A report shall be made to the Department…following the occurrence during the operation of a family day care home of any of the following events: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2020
LIC809 (FAS) - (06/04)
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