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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015828
Report Date: 10/13/2022
Date Signed: 10/13/2022 02:51:54 PM


Document Has Been Signed on 10/13/2022 02:51 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:MOORE FAMILY CHILD CAREFACILITY NUMBER:
198015828
ADMINISTRATOR:MOORE, ASHLEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 925-7353
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:14CENSUS: 5DATE:
10/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Ashley Moore, LicenseeTIME COMPLETED:
03:10 PM
NARRATIVE
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On 10/13/22, Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced case management- other. Upon arrival, LPA met with Licensee Ashley Moore, who gave LPA a tour of the facility. LPA explained the purpose of this visit was to discuss fees.

LPA discussed outstanding fees with Licensee. Licensee was informed that the licensing fees in the amount of $630.40 are overdue. Licensee was provided with the information needed for fees to be paid online with Licensee on 08/08/22 and a letter was sent on 09/19/22. Licensee has written a letter to the department explaining why fees are late and asking for a payment plan. LPA will forward letter to the department. LPA provided Licensee with PIN to pay fees on 09/19/22 and during todays visit. Licensee stated that if the department cannot provide a payment, then she will pay fees as soon as she can.

Licensee stepped away to pick up school aged children at 2:15pm. LPA continued inspection with Licensee assistant Raevyn Biel.

California Code of Regulations, Title 22, Division 12, are being cited on the attached LIC 809D.



Exit interview was conducted with Licensee Assistant Raevyn Biel. Appeal Rights were given and explained.

Upon receipt, Licensee posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
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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Document Has Been Signed on 10/13/2022 02:51 PM - It Cannot Be Edited

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: MOORE FAMILY CHILD CARE
FACILITY NUMBER: 198015828

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/30/2022
Section Cited

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Licensing Fees: An applicant or licensee shall be charged fees as specified in Health and Safety Code Section 1596.803 The requirement is not met as evidenced by: Per LIS, Licensee owes fees of $630.40. This is a potential 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022
LIC809 (FAS) - (06/04)
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