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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495232
Report Date: 06/02/2023
Date Signed: 06/02/2023 12:06:31 PM

Document Has Been Signed on 06/02/2023 12:06 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:MOSS FAMILY CHILDCAREFACILITY NUMBER:
197495232
ADMINISTRATOR:DEBRA MOSSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 674-8424
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/02/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:DEBRA MOSS, APPLICANTTIME COMPLETED:
10:00 AM
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On 06/02/2023 at 9:15am Licensing Program Analyst (LPA) Lisa Clayton met with applicant for an ANNOUNCED PRE-LICENSING INSPECTION. LPA Clayton met applicant Debra Moss. There were no children in care. The home was toured with the applicant for a health and safety inspection.

LPA Clayton returned to the home to inspect the following:


*Inspection of the 2nd floor of the home (bedrooms #1, #2, and #3, bathroom #2 and bathroom #3)

LPA Clayton completed the inspection of the 2nd floor of the home.


Based on today's inspection the following is required prior to issuing a license:
*fingerprint clearances for licensees 2 adult daughters and husband

LPA Clayton provided applicant with the LiveScan forms via email at mommynme.247@gmail.com


An exit interview was conducted, and a copy of this report was provided to applicant. A notice of site visit was provided and must remain posted for 30 days.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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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