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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011242
Report Date: 07/02/2019
Date Signed: 07/02/2019 04:59:15 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:ELEY FAMILY CHILD CAREFACILITY NUMBER:
198011242
ADMINISTRATOR:ELEY, TAMMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 563-3767
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:14CENSUS: 0DATE:
07/02/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:Tammy Eley, LicenseeTIME COMPLETED:
05:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection to the above facility. LPA met with Tammy Eley, Licensee, who guided analyst on a tour of the facility. Also present during the inspection was Licensee's Assistant Tytiana Shelton. There were no children present during the inspection.

During the inspection LPA observed that the facility is under construction (pictures were taken). LPA advised the Licensee to notify the Department of any structural change prior to commencing. Licensee stated that the facility will be closed until 07/07/19 and will re-open on 07/08/19. LPA advised Licensee to notify the Department of any closure time whether it be for construction or vacation time. LPA provided the Licensee with a copy of the LIC 624 Unusual Incident Report to document the construction that is occurring in the home.

The following deficiency listed on the attached deficiencies page is being cited in accordance with California Code of Regulations Title 22.

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. Exit interview was conducted with Tammy Eley, Licensee, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: ELEY FAMILY CHILD CARE
FACILITY NUMBER: 198011242
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2019
Section Cited
CCR
102417(a)
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Alterations to Existing Buildings or Grounds
Prior to making alterations or additions to a family child care home or grounds, the licensee shall notify the Department of the proposed change. This requirement is not met as evidenced by LPA observing that
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Licensee provided written documentation on the construction during the inspection.
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there is construction in the home. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2019
LIC809 (FAS) - (06/04)
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