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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012488
Report Date: 04/12/2024
Date Signed: 04/13/2024 09:54:21 AM

Document Has Been Signed on 04/13/2024 09:54 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:COOK FAMILY CHILD CAREFACILITY NUMBER:
198012488
ADMINISTRATOR/
DIRECTOR:		COOK, AMBERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 701-3931
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
04/12/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Amber Cook, LicenseeTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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Licensing Program Analyst (LPAs) Dayna Chambers and Jonnisha Culbert conducted an unannounced Plan of Correction (POC) case management inspection on April 12, 2024, at 2:15pm, for the purpose of ensuring the facility is maintaining compliance in the areas previously cited on 04/18/2023. Upon Arrival, LPA met with Amber Cook Licensee. LPA observed 4 children and 3 staff in care. LPA toured the facility with Amber Cook, Licensee.
OR The purpose of the POC inspection was determine if Licensee has corrected the deficiencies cited on 04/18/2023. LPA determined the following:
· LPA observed the restroom under sink was free of cleaning products and a lock was installed.
· LPA observed the current drill log and last drill was completed on 03/18/2024.
· LPA observed that staff background was cleared.
· LPA observed all staff have completed EMSA approved Pediatric First Aid and CPR.

Therefore, based on LPAs records review and observations, Some POC’s have been cleared. Additional POC’s will need to be cleared by email.

Exit interview was conducted with Amber Cook, Licensee.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
but not limited to Provider Rights, Appeal Rights were provided and explained.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2024
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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