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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014584
Report Date: 12/04/2019
Date Signed: 12/04/2019 10:33:58 AM

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:CELIS FAMILY CHILD CAREFACILITY NUMBER:
198014584
ADMINISTRATOR:CELIS, KELLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 429-9646
CITY:LAKEWOODSTATE: CAZIP CODE:
90712
CAPACITY:14CENSUS: 11DATE:
12/04/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kelly Celis, LicenseeTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Susann Sanchez conducted a Plan of Correction (POC) inspection on this date. LPA met with Licensee, Kelly Celis, who guided analyst on a tour of the facility. Also present at the facility was Licensee's assistant. LPA observed 11children (9 children, 1 infant, and 1 school aged) at the time of inspection. The purpose of the POC inspection was determine if Licensee has corrected the deficiency cited on 11/26/2019. LPA determined the following:
  • LPA did not observed minors alone, caring for children.
  • LPA reviewed children's files and observed LIC 9224 (Acknowledgment of Receipt) in children's files.
  • LPA observed Notice of Site visit & 809 report from 11/26/2019 posted in the family room (brown bear classroom)

Therefore, based on LPAs records review and observations, POC has been cleared.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted Kelly Celis, Licensee, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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