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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017157
Report Date: 08/23/2021
Date Signed: 08/23/2021 01:17:11 PM

Document Has Been Signed on 08/23/2021 01:17 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:HARRIETTE EVANS SHIELDS CDC/DREW CHILD DEVELOPMENTFACILITY NUMBER:
198017157
ADMINISTRATOR:SHIVERS, EDWINAFACILITY TYPE:
850
ADDRESS:224 E. 126TH STREETTELEPHONE:
(323) 779-6196
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 49TOTAL ENROLLED CHILDREN: 0CENSUS: 19DATE:
08/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Edwina Shivers- Site SupervisorTIME COMPLETED:
01:15 PM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Alicia Bailey to address an Unusual Incident Report that was received in the licensing office on 03/08/2021. LPA met with Site Supervisor Edwina Shivers at 9:18 am who provided LPA a tour of the facility.


The report stated that on 03/08/2021 one person (Site Supervisor ) tested positive for Covid-19. Site Supervisor receive positive test result on 03/06/2021. The parents and staff and DPH was notified. The facility was, clean and sanitize. The notice was posted at the facility and sent out to the parents.

Based on today’s inspection, and interviews conducted, the facility followed the appropriate reporting requirements, Notified Parents, no follow-up is necessary regarding the incident. The Site Supervisor and facility followed the required protocol for reporting requirements" as the incident was reported to Child Care Licensing. It does not appear this incident was the result of a Title 22 violation and the facility followed the appropriate regulations to care for the children in care. No deficiencies were cited on this date.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Alicia Bailey
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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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