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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403941
Report Date: 12/08/2023
Date Signed: 12/08/2023 09:56:59 AM

Document Has Been Signed on 12/08/2023 09:56 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:POLAND FAMILY DAY CAREFACILITY NUMBER:
197403941
ADMINISTRATOR:POLAND, VICTORIA D.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 841-8467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 7CENSUS: 1DATE:
12/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Victoria Poland, LicenseeTIME COMPLETED:
10:15 AM
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On 12/8/2023, Licensing Program Analyst Adrian Risher conducted a case management visit for increased monitoring. LPA met with Victoria Poland, Licensee and explained the purpose of the visit. LPA observed 1 child in care with 1 staff.

The purpose of the visit is to ensure the Licensee maintains a safe and comfortable environment for the children in care. LPA observed Licensee and staff providing proper supervision over the child in care in the backyard.

Based on observations made by the LPA, no deficiencies will be cited today. LPA did not observe any violations during today's visit. Facility will continue to be under increased monitoring on a quarterly basis.

LPA informed Licensee that the end date of the increased monitoring will be December 2024.

Exit interview was completed with Victoria Poland, Licensee. Appeal Rights will be provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2023
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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