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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419908
Report Date: 07/08/2021
Date Signed: 07/08/2021 02:59:13 PM

Document Has Been Signed on 07/08/2021 02:59 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:HALL FAMILY CHILD CAREFACILITY NUMBER:
197419908
ADMINISTRATOR:HALL, CUPIDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 819-2445
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 8DATE:
07/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Cupid Hall, LicenseeTIME COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Denise Gibbs conducted a Case Management Incident inspection to follow up on an incident that occurred at 4:20PM on 7/2/2021 with Cupid Hall, Licensee.

Upon arrival licensee guided LPA on a tour of the facility. There was a total of eight children present and one Assistant.

LPA conducted an interview with the Licensee who stated that police we at the facility on 7/2/2021 around 4:20PM due to a parent phone call. Per interview and record review, Licensee did not call the Regional office or send in a written report in the required time frame.

The deficiencies listed on the following page were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Cupid Hall. Licensee was provided a copy of this report and their appeal rights (LIC 9058).
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Denise Gibbs
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2021
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 07/08/2021 02:59 PM - It Cannot Be Edited


Created By: Denise Gibbs On 07/08/2021 at 02:25 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: HALL FAMILY CHILD CARE
FACILITY NUMBER: 197419908

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/08/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2021
Section Cited
CCR
1597.467(b)(1)(C)

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1597.467(b)(1)(C)reporting requirements(b)(1)report shall be made...by telephone or fax...before the close of the next working day following the...(C)Any unusual incident...that threatens the physical or emotional health or safety of any child.
This requirement was not met as evidenced by
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Licensee will watch Reporting Requirements video on the CCLD website and send LPA a summary of video my email by 7/30/21.
ccld.childcarevideos.org
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Based on observation and record review licensee did not report Unusual Incident in the required time frame.
This 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:Trevino Cochran
LICENSING EVALUATOR NAME:Denise Gibbs
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2021


LIC809 (FAS) - (06/04)
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