Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018568
Report Date: 08/03/2017
Date Signed 08/03/2017 03:21:09 PM

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:DUNCAN FAMILY CHILD CAREFACILITY NUMBER:
198018568
ADMINISTRATOR:JAMISHA JENEE DUNCANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 326-2619
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY:14CENSUS: 0DATE:
08/03/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:58 PM
MET WITH:Jamisha DuncanTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced case management inspection. The purpose of today's visit is to retrieve a signed document (submitted by Licensee Jamisha Duncan) indicating that her mother Carol Bennett no longer resides at this address and has not since Dec of 2014 (deceased).

LPA to file document with closed file 198004563 Bennett Family Child Care.

Exit interview conducted with Licensee Duncan.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2017
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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