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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400831
Report Date: 04/16/2024
Date Signed: 04/16/2024 12:29:53 PM

Document Has Been Signed on 04/16/2024 12:29 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:GILMORE FAMILY CHILD CAREFACILITY NUMBER:
198400831
ADMINISTRATOR/
DIRECTOR:		GILMORE, SHAINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 643-4101
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
04/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Joy Banks, AssistantTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Alicia Mooberry and Jonnisha Culbert conducted a Case Management inspection on this date. LPAs arrived at the home at 9:45 am and met with Joy Banks, Facility Representative. Licensee Shaina Gilmore was not present during inspection.

There were 11 children present including 3 infants. Also, preset was Karen Barnes (S1) and Jaidyn Means (S2), both observed providing care to children present. Record review and interview show that Karen Barnes has been working at the facility for two weeks and has not been associated to the above facility, this poses a potential risk the health and safety of children in care.



Facility roster, staff files and children's files were not available for review, which poses a potential risk to the health and safety of children in care.

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

Exit interview conducted and report was reviewed with the Facility Representative, Joy Banks. Appeal Rights were discussed, and a copy provided.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Alicia Mooberry
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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 04/16/2024 12:29 PM - It Cannot Be Edited


Created By: Alicia Mooberry On 04/16/2024 at 10:54 AM
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: GILMORE FAMILY CHILD CARE
FACILITY NUMBER: 198400831

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/17/2024
Section Cited
CCR
102416(d)(2)

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Prior to employment or initial presence in the child care home, all employees and volunteers... shall...Request a transfer of a criminal record clearance as specified in Section 102370(j)
This requirement is not met as evidenced by
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Per facility representative, S1 will be associated to the facility and proof of correction will be sent to LPA via email by POC due date.
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Based on record review and interview Karen Barnes (S1) has been working a the facility for two weeks and has not been associated to the facility, this poses a potential risk to the health and safety of children in care.
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Type B
04/23/2024
Section Cited
CCR102417(8)(A)

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Each family child care home shall have a current roster of childrenwho are provided care in the facility... This roster shall be available to the licensing agency upon request.
This requierement is not met as evidenced by
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Per facility representative the current and completed roster will be sent to LPA via email by POC due date.
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Based on interview the facility representative did not have facility files available for review, which poses a potential risk to the healt and safety of children 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:Valarie Cook
LICENSING EVALUATOR NAME:Alicia Mooberry
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024


LIC809 (FAS) - (06/04)
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