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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400476
Report Date: 11/05/2021
Date Signed: 11/05/2021 10:28:50 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:FANSHAW FAMILY CHILD CAREFACILITY NUMBER:
198400476
ADMINISTRATOR:FANSHAW, ITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 920-0362
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:14CENSUS: 0DATE:
11/05/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Ita FanshawTIME COMPLETED:
10:40 AM
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On 11/05/21 at 9:45 am, Licensing Program Analyst (LPA) conducted an announced Pre-licensing follow-up Inspection. This is a change of location inspection with the Applicant previously licensed at # 198019771. LPA met with Ita Fanshaw, Applicant, who provided tour of the facility.

The purpose of this inspection was to ensure corrections from prior pre-licensing inspection dated 10/22/21 have been corrected. LPA observed the following:

· A child safety gate has been placed in the stairs leading into the bonus room and a gate was built around the stairs in front of the kitchen door.


· First Aid and Emergency Kit is located in the hallway next to the kitchen.
· Posting of the required forms are next to the front door.
· The firearm is in a black hard plastic case with built in push button locks and a padlock.
· The ammunition is to be stored separately in a black hard plastic case with built in push button locks. LPA did not observe any ammunition, Applicant stated that they don't have any. The firearm will be stored in the off-limit attached garage making it inaccessible to children in care.
· Proof of MMR/TDAP for Daniel Dobens was received.

After further review by the department and when all requirements are met, in accordance to Title 22 regulations, Applicant will be notified if/when License is granted. Once licensed, the Licensee is required to adhere to the terms and limitation as stated on the license.

Exit interview conducted and report was reviewed with Ita Fanshaw.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Elka ChavezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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