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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000603
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:47:08 PM


Document Has Been Signed on 09/29/2023 02:47 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:DENNIS, SANDRA FAMILY DAY CAREFACILITY NUMBER:
198000603
ADMINISTRATOR:DENNIS, SANDRA ANNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 422-3432
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 0DATE:
09/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:
Sandra Dennis, Licensee via Ring Door Bell and PHone		TIME COMPLETED:
02:50 PM
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09/29/23 2:00pm - LPA Chambers arrived at the home for an inspection. LPA observed painters and construction working inside the home. The RING Doorbell was answered by Sandra Dennis stating her son is living in the home now and she retired. The licensee had her son call on his phone and LPA spoke on phone to the licensee. The licensee stated she mailed the request for closure but when asked where she mailed the letter, it was mailed to Sacramento. LPA Chambers provided the licensee with business card and the licensee will email the statement for closure and license directly. The licensee was unavailable for a signature.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna ChambersTELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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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