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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411528
Report Date: 05/26/2023
Date Signed: 05/26/2023 03:06:22 PM

Document Has Been Signed on 05/26/2023 03:06 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:MILLENDER FAMILY CHILD CAREFACILITY NUMBER:
197411528
ADMINISTRATOR:MILLENDER, CAROLYN R.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 635-7295
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY: 14TOTAL ENROLLED CHILDREN: 26CENSUS: 4DATE:
05/26/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Carolyn MillenderTIME COMPLETED:
03:30 PM
NARRATIVE
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At 2:30 p.m. Licensing Program Analysts (LPAs) Franchesca White and T. Tran arrived at the aforementioned facility for the purpose of conducting a complaint investigation. LPAs met with Licensee Carolyn Millender and Adult Daughter (employee) with four (4) children in care at time of inspection.

While conducting Children's file review Licensee failed to provide records for C4 at time of inspection which poses a potential health and safety risk to children in care..

Based on the LPA's observations and records review a Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Carolyn Millender.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Franchesca White
LICENSING EVALUATOR SIGNATURE: DATE: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
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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Document Has Been Signed on 05/26/2023 03:06 PM - It Cannot Be Edited


Created By: Franchesca White On 05/26/2023 at 02:17 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MILLENDER FAMILY CHILD CARE
FACILITY NUMBER: 197411528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
102421(a)

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The licensee shall maintain, in each child's record, the signed and dated notice form required.
This requirement is not met as evidenced by based on record review facility failed maintain C4 record
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Licensee agreed to have parent complete the file for C4 and submit to LPA by or before 6/9/2023 in order to clear this citation.
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 which poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Valarie Cook
LICENSING EVALUATOR NAME:Franchesca White
LICENSING EVALUATOR SIGNATURE:
DATE: 05/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/26/2023


LIC809 (FAS) - (06/04)
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