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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844328
Report Date: 09/18/2019
Date Signed: 09/18/2019 02:12:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:SHAW-HOWARD FAMILY CHILD CAREFACILITY NUMBER:
334844328
ADMINISTRATOR:SHAW-HOWARD, LATEEFAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 315-2827
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:14CENSUS: 11DATE:
09/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Lateefah Shaw-HowardTIME COMPLETED:
02:20 PM
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A Case Management Visit is being conducted in response to the receipt of an Unusual Incident (UIR) from the facility. Initial visit was 6/21/19. The Unusual Incident Report was received by the Licensing Agency on 6/13/19. LPA met with the Licensee, Lateefah Shaw-Howard. It indicates on the Unusual Incident Report, dated 6/11/19, it was reported that the Licensee's assistant was late picking up a child from school. The school staff contacted the parent. The parent picked up the child from school. From interviews conducted, the child was supervised by the teachers at the school.

Therefore, based on the information obtained during the visit, there appears to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was conducted and a copy of this report was provided to facility staff.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2019
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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