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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005535
Report Date: 06/26/2023
Date Signed: 06/26/2023 12:42:38 PM


Document Has Been Signed on 06/26/2023 12:42 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:JEFFERS FAMILY CHILD CAREFACILITY NUMBER:
198005535
ADMINISTRATOR:JEFFERS, LINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 626-9149
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:14CENSUS: 7DATE:
06/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Linda JeffersTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management inspection. Licensee indicated that she is closing the daycare as of June 30th, 2023 (close of business). LPA retrieved a signed and dated letter from Licensee indicating the closure. Licensee also surrendered her original License to LPA. Note: Licensee has a digital photocopy as well. Licensee was caring for school age relatives and three preschool children and one infant child.

LPA informed Licensee that the facility will be process closed at June 30th, 2023 at 5:30pm.

LPA informed Licensee information regarding with Safe Sleep PIN 20-24-CCP. LPA explained these regulations and advised Licensee to ensure that she provides care and supervision adhering to the information provided until closure.

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. This report along with a copy of the appeal rights was provided. Exit interview was conducted with Licensee Linda Jeffers.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023
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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