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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201970
Report Date: 08/12/2019
Date Signed: 08/12/2019 12:32:16 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:MOUNT OLIVE WILLA LEE NURSERY SCHOOLFACILITY NUMBER:
191201970
ADMINISTRATOR:NULTY, JANETTEFACILITY TYPE:
850
ADDRESS:4519 WILLA LEE AVENUETELEPHONE:
(818) 249-9200
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:21CENSUS: 18DATE:
08/12/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Janette NultyTIME COMPLETED:
12:45 PM
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On 08/12/19 LPA Dorsey conducted an unannounced Case Management visit to remove a citation from a random visit that was conducted 08/01/19. During the visit on 08/01/19 while attempting to final print the report LPA experienced a consistency check. During the visit the facility was cited for not having current CPR/First Aid, while going through consistency check Director Janette Nulty was able to provide proof that she had taken the training. During this case management visit LPA Dorsey removed the citation from the report, final printed the report and gave a copy of the report to the Director along with the appeal rights and the notice of site visit.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2019
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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