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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020093
Report Date: 12/01/2021
Date Signed: 12/01/2021 02:47:28 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:ALLEN FAMILY CHILD CAREFACILITY NUMBER:
198020093
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
12/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Keisha Allen, LicenseeTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPA) A. Lucero conducted an unannounced case management inspection to the above facility on 12/01/2021 at 2:15PM. LPA met with Keisha Allen, Licensee, who guided analysts on a tour of the facility. The purpose of this inspection is to follow-up on a request for a capacity increase.

There were seven children present upon arrival. The department received a granted Fire Clearance for maximum capacity of 14 children. Licensee has a current Pediatric CPR/First Aid issued by the American Heart Association with an issue date of 08/24/2021.

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 with Keisha Allen, Licensee, including Appeal Rights.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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