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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
198008514
Report Date:
06/21/2023
Date Signed:
06/21/2023 02:34:57 PM
Document Has Been Signed on
06/21/2023 02:34 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:
RANDALL-WALKER FAMILY CHILD CARE
FACILITY NUMBER:
198008514
ADMINISTRATOR:
RANDALL-WALKER VALENCIA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(562) 920-6308
CITY:
LAKEWOOD
STATE:
CA
ZIP CODE:
90713
CAPACITY:
14
CENSUS:
0
DATE:
06/21/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:40 PM
MET WITH:
Valencia Randall-Walker
TIME COMPLETED:
01:40 PM
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Attempted - requesting inactive status - signature on file
SUPERVISOR'S NAME:
Valarie Cook
TELEPHONE:
(323) 513-3858
LICENSING EVALUATOR NAME:
Dayna Chambers
TELEPHONE:
(323) 558-2962
LICENSING EVALUATOR SIGNATURE:
DATE:
06/21/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/21/2023
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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