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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494934
Report Date: 02/10/2022
Date Signed: 02/10/2022 11:48:48 AM

Document Has Been Signed on 02/10/2022 11:48 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:MOSS FAMILY CHILD CAREFACILITY NUMBER:
197494934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
02/10/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Debra MossTIME COMPLETED:
12:00 PM
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On February 10, 2022 Licensing Program Analyst (LPA) Doris Whitmore and Licensing Program Manager (LPM) Karren Starks conducted an announced inspection with applicant Debra Moss, for the purpose of observing the corrections from the prior pre-licensing inspection on 2/2/22.

LPA Whitmore and LPM Starks observed the following corrections: The fireplace in the living room has a secured sturdy fence around it with bolt locks around at the bottom, The heating air duct has a Secured screen to prevent access. Applicant secured the drawers and the cabinet beneath the sink in the kitchen. The television cords in the dining room were covered to prevent a hazard. The cabinets in the laundry room were made inaccessible with a secured lock at the top. Electrical outlets within the childcare areas were covered. Safety knobs were placed on the doors on the right side of the hallway.

Applicant provided a declaration for outdoor supervision due to stating the children will be taken to a local park. Applicant was also reminded that the vehicle that is used is to be properly operable, insurance and registration must be maintained, and the children must be placed in proper car seats. The driver of the vehicle must have a valid driver’s license.

The applicant was also advised to ensure the area mats in child care areas are properly secured to prevent a tripping hazard and to also post the requires posting on the parent board which is located in the laundry room

Once the applicant provides the LPA with a picture of the parent board then the file will be given for managerial review prior to licensure.

An exit interview was conducted.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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