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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402163
Report Date: 04/19/2022
Date Signed: 04/19/2022 11:42:34 AM

Document Has Been Signed on 04/19/2022 11:42 AM - 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:EVANS FAMILY CHILD CAREFACILITY NUMBER:
197402163
ADMINISTRATOR:EVANS, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 631-5556
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mshairi Evans - LicenseeTIME COMPLETED:
11:58 AM
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Licensing Program Analyst (LPA) Alicia Bailey conducted an unannounced case management inspection, LPA Bailey met with Licensee Mshairi Evans at 10:00 am who guided this LPA Bailey on a tour of the facility. Today inspection is a follow up from previous inspection visit on 03/22/2022 for proof of correction. At 10:15 am during the inspection LPA Bailey discussed, assessed and noted individuals residing in the home. This is a one story home consists of 4 bedrooms and 2 bathroom. Areas used by the children include the day-care room, two bedrooms one (1) restroom, kitchen and back yard. The Licensee stated there are no other license held at this facility. The Licensee Evans operates the facility as private school with age range 6 to 12 There were no children during time inspection. Licensee states that there are currently eleven children enrolled. Facility hours of operation Monday thru Friday 7:30 am to 4:00pm.

At 10:30 am LPA Bailey reviewed personnel file CPR & 1st Aid , mandated reporter and immunization was in compliance.

At 10:50 am LPA Bailey reviewed fire extinguisher was services on 03/25/2022

At 11: 20 am LPA Bailey reviewed 11 children file was in compliance .

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with licensee Evans but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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