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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202127
Report Date: 10/17/2019
Date Signed: 10/17/2019 01:58:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:TEMPLE AHAVAT SHALOM EARLY CHILDHOOD EDUCATION CT.FACILITY NUMBER:
191202127
ADMINISTRATOR:TESSA CRAMERFACILITY TYPE:
850
ADDRESS:18200 RINALDI PLACETELEPHONE:
(818) 360-5183
CITY:NORTHRIDGESTATE: CAZIP CODE:
91326
CAPACITY:72CENSUS: 37DATE:
10/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tessa Cramer.TIME COMPLETED:
01:30 PM
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Margarit Sislyan, Licensing Program Analyst (LPA) met with facility Director, Tessa Cramer. LPA toured the facility and observed the facility is in compliance.

Consultation was provided.

EXIT INTERVIEW
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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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