<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494774
Report Date: 04/04/2023
Date Signed: 04/04/2023 09:47:30 AM

Document Has Been Signed on 04/04/2023 09:47 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ALLEN FAMILY CHILD CAREFACILITY NUMBER:
197494774
ADMINISTRATOR:BEVERLY S ALLENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 505-5086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Beverly Allen, LicenseeTIME COMPLETED:
10:05 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 04/04/2023, Licensing Program Analyst (LPA) Adrian Risher conducted an unannounced Plan of Correction inspection to determine if the deficiencies cited on 03/16/2023 have been cleared. LPA met with Beverly Allen, Licensee and toured the facility. There were 9 children present at the time of inspection with 2 assistants.

On 03/16/2023, LPA Risher conducted an Annual Inspection and cited for Child's Records. Licensee did not have completed children's files. LPA Risher provided Licensee with LIC 311D FORMS/RECORDS TO KEEP IN YOUR FAMILY CHILD CARE HOME.

During today's inspection, LPA reviewed the children's files to determine if they are complete.

Licensee provided the following items to LPA: LPA reviewed the children's files during inspection.

Deficiencies cited on 03/16/2023 have been cleared. Plan of correction letter was provided to the licensee.

Exit interview was conducted and a copy of the report was provided. Appeal rights were reviewed and provided.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Adrian Risher
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1