<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493875
Report Date: 11/09/2021
Date Signed: 11/09/2021 01:57:39 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:FULLER FAMILY CHILD CAREFACILITY NUMBER:
197493875
ADMINISTRATOR:FULLER, MARLOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 505-9749
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:14CENSUS: 9DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Marlo Fuller, LicenseeTIME COMPLETED:
02:10 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
***Report Amended to remove the wrong Civil Penalty Assessment Form(LIC421IM) which was given to licensee during Annual Inspection on 10/28/2021.***

Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced case management inspection for the purpose of providing Licensee with the correct Civil Penalty Assessment Form (LIC421BG)

LPA completed a census (9 children were in attendance). LPA observed 8 children napping and 1 child awake at child table in living room. LPA observed Licensee with two Assistants during visit.


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 Marlo Fuller, Licensee. Appeal Rights were provided.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1