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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400006
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:24:17 PM

Document Has Been Signed on 07/10/2024 01:24 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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
198400006
ADMINISTRATOR/
DIRECTOR:		JENAE GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 713-1163
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
07/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Jenae Green, LicenseeTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) K. Dunlap and F. White arrived at the above facility for the purpose of an unannounced Case Management/Incident inspection. LPA Dunlap announced the purpose of the visit and was granted entry into the facility by Licensee, Jenae Green. This is a unannounced visit based upon Licensee filing UIR with department on June 21, 2024.

There are 17 children enrolled, and 14 children present at the time of inspection. All adults in the home were discussed and have current criminal background clearance. Per Licensee, the hours of operation are 12:00 a.m. to 12:00 a.m. (Monday - Sunday).

At approximately, 10:30am LPA Dunlap observed the temporary playground located that has a locked fence at the beginning of driveway that will be used during the construction of the Accessory Dwelling Unit (ADU). The temporary playground has the following items: sand toys, balls, blocks, mini basketball stand with hop, water and sand table, mini picnic tables, obstacle course materials, and mini scooters. LPA also observed a covered sand area with synthetic sand.

At approximately, 10:45am LPA Dunlap observed a locked cabinet located on the temporary playground. Locked cabinet has cleaning supplies, and materials.

At approximately, 10:55am LPA Dunlap observed previous playground that is under construction has a gate before entry into the area. The actual area where the Accessory Dwelling Unit (ADU) will be located has a gated black mesh net fence with a lock surrounding the area to ensure that no children have access into the area. The foundation for the area has been dug up and Licensee stated that the Accessory Dwelling Unit (ADU) will not be connected to the housing area, and the unit will have a separate address. Construction will be 3-4 months.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: GREEN FAMILY CHILD CARE
FACILITY NUMBER: 198400006
VISIT DATE: 07/10/2024
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Licensee stated that once Accessory Dwelling Unit (ADU) is completed that the surrounding area will be used as a play area for children.

LPA informed Licensee that potential tenant/occupant must obtain criminal background clearance, and TB (no more than a year old). Once construction is completed that a new facility sketch must be submitted to the department.

At approximately 11:10am, LAP Dunlap observed double doors leading from the room where children are kept (Bedroom #3) to the previous playground has child safety locks to ensure that children do not have access to previous playground.

The Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

Notice of Site Visit

A notice of site visit was given and must remain posted for 30 days

Exit Interview - conducted and report was reviewed with Jenae Green, Licensee.

Copy of report and appeal rights given to Jenae Green, Licensee.

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SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Keneisha Dunlap
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC809 (FAS) - (06/04)
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