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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200465
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:59:30 AM


Document Has Been Signed on 06/20/2023 11:59 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SHERMAN OAKS LUTHERAN CHILDREN'S CENTERFACILITY NUMBER:
191200465
ADMINISTRATOR:DIANE NIXONFACILITY TYPE:
850
ADDRESS:14847 DICKENS STREETTELEPHONE:
(818) 784-9480
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91403
CAPACITY:78CENSUS: 40DATE:
06/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Director - Kimberly OgasTIME COMPLETED:
12:15 PM
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On 06/20/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced complaint visit for the purpose of case management - other. LPA met with Kimberly Ogas, Director and observed 40 children and 12 adults.

LPA observed a small classroom (Bears Classroom) and will request a fire clearance to determine occupancy to ensure the health and safety of children in care.

An exit interview was conducted and a copy of this report along with a Notice of Site Visit was provided to the Director.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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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