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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405743
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:34:46 PM

Document Has Been Signed on 02/18/2022 01:34 PM - 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:PERGES AND LEAVELL FAMILY CHILD CAREFACILITY NUMBER:
197405743
ADMINISTRATOR:PERGES, S. AND C. LEAVELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 918-3725
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/18/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Shenae Perges- LicenseeTIME COMPLETED:
01:30 PM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Alicia Bailey to address an Unusual Incident Report that was received in the licensing office on 01/10/2022. LPA Bailey met with Licensee at 1:20 PM who provided LPA a tour of the facility.

The report stated that on 01/10/2022 one person ( Licensee ) tested positive for Covid-19. The parents and staff and DPH was notified. The facility was, clean and sanitize. The notice was posted at the facility and sent out to the parents.



Based on today’s inspection, and interviews conducted, the facility followed the appropriate reporting requirements, Notified Parents, no follow-up is necessary regarding the incident. The licensee followed the required protocol for reporting requirements" as the incident was reported to Child Care Licensing. It does not appear this incident was the result of a Title 22 violation and the facility followed the appropriate regulations to care for the children in care. No deficiencies were cited on this date.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2022
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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