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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400161
Report Date: 11/15/2022
Date Signed: 11/15/2022 03:23:32 PM

Document Has Been Signed on 11/15/2022 03:23 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:MEYERS FAMILY CHILD CAREFACILITY NUMBER:
198400161
ADMINISTRATOR:ALMA MEYERSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 841-8403
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
11/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Melody G.TIME COMPLETED:
03:35 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management Incident inspection. This inspection is regarding incident that took place on August 25, 2022. Licensing Program Analyst met with Assistant Melody G. who provided assistance for the inspection. LPA observed cleared Assistant caring for two preschool children and one infant.

During the course of these inspections, LPA conducted interviews with five (5) children and two staff. LPA also attempted interviews with adult #1 and child #1 who were unavailable. In addition, LPA reviewed incident reports provided by the facility. LPA Birks also submitted a request for documentation from an outside agency on August 31st, 2022. LPA has not received any documents as of today.

Note: Licensee Alma Meyers reported the incident to the department within a timely manner (within 24 hours).

At this time, there are no corroborated disclosures or documentation that would substantiate a Title 22 violation. Therefore, there are no citations in regards to this incident.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Assistant Melody G.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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