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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008245
Report Date: 12/11/2019
Date Signed: 12/11/2019 02:59:04 PM

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:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
198008245
ADMINISTRATOR:ADAMS, SHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 904-5977
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 2DATE:
12/11/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sheryl Adams, LicenseeTIME COMPLETED:
03:15 PM
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An unannounced Case Management-other inspection has been conducted on this date by Licensing Program Analyst (LPA) Susann Sanchez. Upon arrival, LPA was greeted and let into the residence by the licensee Sheryl Adams, who was with her adult daughter, Miranda Sutherland, and her grandchild and foster child. Licensee provided LPA a tour of the facility inside and outside. Census was taken.

During today's inspection, LPA collected the children's roster and took pictures of the facility.

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.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Licensee Sheryl Adams. Appeal Rights were provided and explained,.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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