Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417694
Report Date: 07/21/2015 12:00:00 AM
Date Signed 07/21/2015 10:32:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:HAMPTON FAMILY CHILD CAREFACILITY NUMBER:
197417694
ADMINISTRATOR:HAMPTON, DEANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 295-5219
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:14CENSUS: 0DATE:
07/21/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Deanna HamptonTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a Case Management investigation for an incident reported on 01/08/2015. The child recovered from her ear infection and as stated it was an effect of the ear infection that the child had the temperature. The grandmother still has the medical card, but the licensee has the medical consent form and an affidavit for medical care since they are going through the guardianship process.
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No deficiencies cited.

An exit interview and copy of report give
SUPERVISOR'S NAME: Scott HerringTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (310) 337-3753
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2015
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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