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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413657
Report Date: 06/04/2025
Date Signed: 06/05/2025 08:49:02 AM

Document Has Been Signed on 06/05/2025 08:49 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:HOWARD FAMILY CHILD CAREFACILITY NUMBER:
197413657
ADMINISTRATOR/
DIRECTOR:		HOWARD, CHERYLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 753-9041
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
06/04/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:42 AM
MET WITH:Cheryl HowardTIME VISIT/
INSPECTION COMPLETED:
01:23 PM
NARRATIVE
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On 06/04/2025, Licensing Program Analyst (LPA) Ranita Richmond conducted an unannounced visit to the above-named Home to conduct an Annual Random Inspection. LPA was greeted by Licensee Cheryl Howard. Assistant Donna Williams was present during the visit. LPA Richmond observed 6 children in care, being supervised and cared for appropriately by licensee and one fingerprint cleared assistant. Hours of operation are Monday through Friday and is open 23 hours of the day. The home is closed daily at 3 am.

LPA toured the home inside for a Health and Safety inspection. LPA was unable to tour the outside of the home due to licensee having work done on the roof and painting of the exterior of the home. The home has heating and ventilation for safety and comfort. The home has a screened fireplace in the living room of the home.

LPA Richmond confirmed with licensee that the home is a single story, single-family home that consists of: Living room, dining room, family room, kitchen, three bedrooms, two bathrooms, detached garage, and gated back yard.

Licensee has two dogs. One dog is a 1year old Brendel Frenchie named Cash. One is a 4 month old white Maltese Poodle named Tori. Tori resides in the home in bedroom 2 and goes out around 5:30pm. Cash resides in the detached garage. Both dogs have up to date immunizations. Licensee provided LPA with copy of immunizations for both dogs.

Per licensee, The OFF LIMITS AREAS are as follows: Kitchen, living room, dining room, bedrooms #1, #2, & #3, bathroom #2, and detached garage all of which are made inaccessible to children in care by child safety gates, closed and/or locked doors, and visual supervision.

Per licensee, The ON LIMIT AREAS are as follows: Family room (main daycare area/eating/napping/isolation room), bathroom #1, and gated back yard.
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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/05/2025 08:49 AM - It Cannot Be Edited


Created By: Ranita Richmond On 06/04/2025 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(9)(A)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (9) Each family child care home shall have a written disaster plan of action prepared on a form approved by the Department. All children, age and ability permitting, and the provider, the assistant provider, and other members of the household, shall be instructed in their duties under the disaster plan. As their age and ability permit, newly enrolled children shall be informed promptly of their duties as required in the plan. (A) Each family child care home shall conduct fire drills and disaster drills at least once every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation,interview, record review, the licensee did not comply with the section cited above fire/ disaster drill last completed July 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Licensee will complete a fire/disaster drill within 48 hours and provide documentation to the Department.
Type B
Section Cited
CCR
102425(b)(1)(A)
Infant Safe Sleep
(b) Cribs or play yards shall be free from all loose articles and objects. (1) Pacifiers shall be allowed in the crib or play yard if the following provisions are in place: (A) There shall not be anything attached to the pacifier.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above plushy attached to pacifier of sleeping infant which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Licensee will immediately detach plushy from pacifier and return to parents today (06/03/25). Licensee will no longer utilize attachments on pacifiers.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maureen Neal
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2025 08:49 AM - It Cannot Be Edited


Created By: Ranita Richmond On 06/04/2025 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above licensee completed mandated reporter training last on 9/12/22 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Licensee will complete mandated reporter training and provide completion certificate to the Department for review. Licensee will update mandated reporter training every two years as necessary.
Type B
Section Cited
CCR
102425(c)
Infant Safe Sleep
An Individual Infant Sleeping Plan [LIC 9227 (3/20)] shall be completed for each infant up to 12 months of age the provider has in care and included in the infant's file at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above C1 file is missing LIC 9227 form which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Licensee will complete LIC 9227 and submit to the Department for review within 48 hours. Licensee will complete LIC 9227 forms for all infants enrolled under 12 months of age and place in file for review.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Maureen Neal
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/05/2025 08:49 AM - It Cannot Be Edited


Created By: Ranita Richmond On 06/04/2025 at 12:32 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102425(j)(2)(D)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, record review, the licensee did not comply with the section cited above infant sleep charts unable to be reviewed for infants up to 24 months which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/18/2025
Plan of Correction
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Licensee will complete infant sleep charts for all infants 24 months of age and provide to the Department within 48 hours for review.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Maureen Neal
NAME OF LICENSING PROGRAM MANAGER:
Ranita Richmond
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/04/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657
VISIT DATE: 06/04/2025
NARRATIVE
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Parents and children enter the home through the front door. Which places you inside of the living room/ dining room areas. To the left is an entry way that leads to bedrooms 1, 2, and bathroom 1. If you walk straight through the double doors in the living room/dining room area you are in the family room. To the right in the family room is an entry way that leads to the kitchen. Inside the kitchen is a door that leads to the side of the house. Inside the family room to the left is a door that leads to bedroom #2. Inside the family room to the far left is a door that leads to bedroom #3. Inside bedroom #3 is bathroom #2. Inside the family room to the far right is a door that leads to the gated backyard and detached garage.

Licensee is aware that the children must nap and have meals in the home. Licensee provides meals and appropriate beverages.

LPA Richmond observed a fully charged 3A:40B:C Fire Extinguisher in the kitchen. Fire extinguisher purchased in January 2025. LPA observed working carbon monoxide detector in the family room. LPA observed a working smoke detector in the family room.

There are no firearms or ammunition on the premises. There are no pools, ponds, or other bodies of water on the premises.

LPA Richmond observed age-appropriate toys, books, and furnishings.

LPA reviewed fire drill/disaster log. Based on interview with licensee and disaster log, it was determined that last fire drill was completed July 2023. Type B citation cited. See LIC 809D. LPA advised licensee to complete a fire drill within the next 48 hours. LPA advised licensee that fire/ disaster drills must be completed every 6 months.

At approximately 9:37am LPA observed C1 sleeping with pacifier in his mouth. The pacifier has a plushy attached to the pacifier. Type B citation sited. See LIC 809D. LPA requested infant sleep chart for C1. Per licensee, no infant sleep charts completed. Type B citation cited. See LIC 809D. LPA advised licensee that infant sleep charts are necessary for all infants up to 24 months.

LPAs reviewed 6 children’s files. Children’s files are missing LIC 9227 for C1. Type B citation cited. See LIC 809D. LPA advised that all infants enrolled in family childcare home who were enrolled under the age of 12 months must sleep on their back until section C is completed by caregiver and section D is completed by provider. 24 hours after completion infants are allowed to remain in position other than back if they roll into the position.

Licensee is in compliance with immunizations requirements for childcare providers. LPA Richmond observed the licensee to have current and updated CPR/First Aid. Licensee mandated reporter training completed 09/12/22. Type B citation cited. See LIC 809D.


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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657
VISIT DATE: 06/04/2025
NARRATIVE
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LPA discussed infant sleep chart with licensee. LPA advised licensee that chart must include the infant full name, date of birth, date, initial, time, position of sleep, comments, and waiver if applicable. LPA advised licensee that infant sleep must be completed daily in real time of the infant’s sleep. LPA advised licensee that the infant sleep chart must be completed for all infants up to 24 months in age.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep web page at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC)

website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.


Incidental Medical Services (IMS) are not currently being provided.

Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA Richmond reminded Licensee of the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to childcare providers and Resource and Referral Agencies (R&R) throughout California.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657
VISIT DATE: 06/04/2025
NARRATIVE
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LPA provided applicant with the LIC 311D, Forms/Records to Keep In Your Family Child Care Homes, children’s forms/records, facility forms/records, and information to be posted. LPA Richmond gave applicant a packet of all required forms, and posters and reviewed following forms:

CHILDREN'S RECORDS REQUIREMENTS:

· LIC 700 Identification and Emergency Information


· LIC 627 Consent for Emergency Medical Treatment
· LIC 282 Affidavit Regarding Liability Insurance
· LIC 9150 Parent Notification Additional Children in Care
· LIC 9927 Individual Infant Sleeping Plan
· LIC 995A Notification of Parent’s Rights
· LIC 613A Personal Rights
· Immunization Record
FACILITY RECORDS:
· LIC 624B Unusual Incident/Injury Report
· LIC 9040 Child Care Facility Roster
· LIC 9052 Employee Rights,
· LIC 9108 Statement Acknowledging Requirement to Report Child Abuse
· LIC 9149 Property Owner/Landlord Consent Form
· LIC 9151 Property Owner/Landlord Notification Form
· Proof of current pediatric CPR and First Aid Certificates
· Copy of your deed or lease/rental agreement
· Documentation of Fire and Disaster drills
· Proof of immunizations against pertussis (TDAP), measles (MMR), and influenza
· Mandated Reporter certificate – www.mandatedreporterca.com – must be renewed every two (2) years.

FORMS TO BE POSTED


· LIC203 Facility License
· LIC 610A Emergency Disaster Plan
· LIC 9148 Earthquake Preparedness Checklist
· PUB394 Notification of Parents Rights Poster

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: HOWARD FAMILY CHILD CARE
FACILITY NUMBER: 197413657
VISIT DATE: 06/04/2025
NARRATIVE
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In addition, LPA Richmond informed applicant of the following:

o There is an effective 24/7 ban on smoking tobacco in a home that is licensed as a family day care home, and in those areas of the family day care home where children are present.
o Children and Staff records must be maintained and updated as needed and must be available for review by the Department.
o Saucer chairs, bouncers, walkers, or any similar items are prohibited.
o All adults living and working in the home shall be made of aware of the Departments right to inspection authority, which includes but not limited to the right to enter the home when children are being cared for, interview children and adults and review documentation.
o LPA provided and advised the applicant how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

An exit interview was conducted, a copy of this report was read and provided to Licensee Cheryl Howard.

Five (5) Type B Citations issued during this visit per Title 22 Regulations and Health and Safety Codes. See LIC 809D.

Notice of Site Visit was provided and required to be posted for 30 days.

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NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Ranita Richmond
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC809 (FAS) - (06/04)
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