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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016449
Report Date: 11/14/2024
Date Signed: 11/14/2024 02:04:41 PM

Document Has Been Signed on 11/14/2024 02:04 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:HUFFMAN FAMILY CHILD CAREFACILITY NUMBER:
198016449
ADMINISTRATOR/
DIRECTOR:		HUFFMAN, ANGELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 567-3647
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 16CENSUS: 4DATE:
11/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:56 PM
MET WITH:Angela Huffman / LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Ashley Calderon arrived to the facility and met with Staff Assistant Daiza Huffman who granted LPA entrance to the facility. The purpose of the inspection was to conduct a complaint inspection, due to record review and observations LPA conducted a Case Management inspection.

Upon arrival LPA observed 4 children and 2 staff present. At 12pm Licensee Angela Huffman arrived at the facility. LPA conducted a tour facility tour.

LPA reviewed Children's Records for children present on today's visit. Records reviewed for Child #1-Child #4. Licensee was unable to provide LPA Calderon records for Child #1 and Child #2. Child # 3 had incomplete records. Licensee stated Child #1 and Child #2 stated unable to find documentation's and will have them re done. Per Licensee, Child #3 stated will need to complete documentation's for her own foster child.

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



An exit interview was conducted with Licensee Angela Huffman. Appeal Rights and Notice of Site visit was given, must remain posted for 30 days.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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Document Has Been Signed on 11/14/2024 02:04 PM - It Cannot Be Edited


Created By: Ashley Calderon On 11/14/2024 at 01:42 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: HUFFMAN FAMILY CHILD CARE
FACILITY NUMBER: 198016449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/29/2024
Section Cited
CCR
102421a

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(a) The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).

This requirement is not met as evidenced by:
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Licensee will have Child #1 and Child #2 guardian complete documentation's. Child #3 Licensee foster child, she will complete C3 records. All records will be sent to LPA Calderon by poc due date.
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Based on observation/record review regarding children records, Child #1 and Child #2 no file for children and no documentation's provided. Child #3 file incomplete missing docs, the licensee did not comply with the section cited above in [3] out of [3] children records, which poses a potential health, safety or personal rights risk to persons 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:Denise Gibbs
LICENSING EVALUATOR NAME:Ashley Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
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