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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198005969
Report Date: 11/04/2021
Date Signed: 11/04/2021 11:40:21 AM

Document Has Been Signed on 11/04/2021 11:40 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LANGSTON FAMILY CHILD CAREFACILITY NUMBER:
198005969
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 8DATE:
11/04/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lisa Langston, LicenseeTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Susann Sanchez made an unannounced case management- other visit regarding the Stipulation Modifying Proposed Decision and Order (SMPDO) dated 10/01/2021. LPA met with Licensee Lisa Langston who guided analyst on a tour and census was taken. LPA and Licensee, Lisa Langston discussed the Stipulation Modifying Proposed Decision and Order (SMPDO) conditions. The SMPDO is approved with the following conditions:

· Within the first six months of probation, Heaven Bowen must complete ten (10) hours of training course in anger management.
· Heaven Bowen shall provide care and supervision to clients in care at the facility only under the supervision of the licensee or another staff member.

LPA confirmed employee Heaven Bowen is still employed at the facility. LPA confirmed Heaven Bowen scheduled and Heaven Bowen is not scheduled to work alone and the licensee has ensured there is a staff with her throughout her shift. Licensee will submit proof of anger management class to LPA via email once class is completed. Declaration was collected by the licensee during inspection.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee Lisa Langston

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2021
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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