<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197415189
Report Date:
06/15/2022
Date Signed:
06/15/2022 06:38:15 PM
Document Has Been Signed on
06/15/2022 06:38 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:
MATTHEWS FAMILY CHILD CARE
FACILITY NUMBER:
197415189
ADMINISTRATOR:
MATTHEWS, SHAMECKA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(323) 734-3763
CITY:
LOS ANGELES
STATE:
CA
ZIP CODE:
90018
CAPACITY:
12
TOTAL ENROLLED CHILDREN:
12
CENSUS:
0
DATE:
06/15/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
09:00 AM
MET WITH:
Shamecka Matthews, Licensee
TIME COMPLETED:
09:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Attempted
SUPERVISORS NAME
:
Valarie Cook
LICENSING EVALUATOR NAME
:
Dayna Chambers
LICENSING EVALUATOR SIGNATURE
:
DATE:
06/15/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1