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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021036
Report Date: 09/28/2022
Date Signed: 09/28/2022 11:53:35 AM

Document Has Been Signed on 09/28/2022 11:53 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:MARSHALL FAMILY CHILD CAREFACILITY NUMBER:
198021036
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/28/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Courtney MarshallTIME COMPLETED:
12:00 PM
NARRATIVE
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On 9/28/2022 at 10:45 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an announced pre-licensing follow-up visit for the above address, which was corrected in the office from the last visit. Covid Risk assessment was conducted before entering the facility. LPA met with Courtney Marshall, applicant who guided LPA to the areas that required correction from the last inspection on September 22, 2022. LPA observed applicant’s infant child during the visit, there were no other adults present at the time of inspection.

-LPA observed rose bushes that had been removed. (LPA took photos).

-LPA tested the Carbon Monoxide and found operable.

-LPA observed parent board located in the living room with all the required documents. (LPA took photos).

-LPA was given a copy of the Preventive Health and Safety training certificate including the Lead Exposure that was completed on September 25, 2022.

Exit interview was conducted and a copy of this report and appeal rights was given to Applicant, Courtney Marshall along with notice of site visit.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2022
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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