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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494269
Report Date: 11/14/2019
Date Signed: 11/19/2019 09:02:59 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:BOOKER FAMILY CHILD CAREFACILITY NUMBER:
197494269
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
11/14/2019
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:ApplicantTIME COMPLETED:
09:51 AM
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On 11/14/2019 Licensing Program Analyst Chandler made an announced visit to the above location for the purpose of inspecting corrections required prior to licensing. During a visit conducted on 11/06/2019 applicant did not have access to the detached garage located on the premises, there was no thermometer in the first aid kit and applicant was to remove the refrigerator from the day care area. On todays visit LPA inspected the garage, there was no evidence of habitation, garage will be used for storage only. LPA observed the thermometer and the refrigerator was relocated to the kitchen.

Based on todays inspection the home shall be recommended for licensure as of today 11/14/2019.

Applicant understands that once the home is licensed the home shall not operate outside the scope of the license.


Interview was concluded.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2019
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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