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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198010536
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:22:48 PM


Document Has Been Signed on 07/24/2024 12:22 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:TILLMAN FAMILY CHILD CAREFACILITY NUMBER:
198010536
ADMINISTRATOR:TILLMAN, TRACEYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 209-8686
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:14CENSUS: 0DATE:
07/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Adriane Carrington, Licensee AssistantTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Sanchez and LPA Calderon arrived to the facility and met with Staff Adriane Carrington, Assistant gave LPAs a tour of the facility including "off limit" areas. The purpose of the inspection was to conduct a complaint inspection. Due to LPAs observations and staff interview, LPAs conducted a Case Management inspection.

The following was observed:
  • At 10:00am, staff stated Licensee does not live in the home. Due to lack of information. LPAs will return to gather more information. At 11:20am, LPAs informed Licensee an additional fire clearance may be needed.
  • At 10:05am, staff stated that Licensee is on vacation. The department was not notified and assistant did not have access to staff files so LPAs cannot verify if staff is qualified to be alone with the children. Type B was cited.
  • At 10:20am, staff stated an incident occurred recently regarding day-care children on 07/14/24, and the local police came to the facility on 07/16/24. Staff stated at 10:21am, that Licensee didn't give her specific details regarding the incident. No current incidents were reported to the department. Type B was cited.


At 11:00am, LPAs and Licensee spoke on the phone regarding incidents and plan of correction(s).

The following deficiencies listed on the attached LIC 809-D (deficiency page) are being cited in accordance with California Code of Regulations Title 22, Division 12, Chapter 1 and Section CCR & H&S.



An exit interview was conducted with Staff Adriane Carrington. Appeal Rights and Notice of Site visit was given.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024
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 2


Document Has Been Signed on 07/24/2024 12:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: TILLMAN FAMILY CHILD CARE
FACILITY NUMBER: 198010536

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2024
Section Cited
CCR
102416.2(a)

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102416.2(a) Reporting Requirements (a)The licensee shall report the following information the Department by telephone or fax within the Department's next business day and during normal working hours (8am to 5pm). The requirement was not met as evidenced by: based on interviews conducted with Licensee
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Licensee called LPAs at 11:00am, per Licensee understands that all incidents need to be reported within the 24 hours. LPAs printed "Reporting Requirments," Licensee stated that she will review regulation when she returns from vacation on 07/27/24.
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admitted that she did not report incident that occurred on 07/14/24 and police came to her home 07/16/24. Licensee stated she did not report because she did not that she had to. Per Licensee, staff is qualified but but paperwork is in the garage. This poses a potential risk to the health and safety of 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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2024
LIC809 (FAS) - (06/04)
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