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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224046
Report Date: 11/22/2019
Date Signed: 11/22/2019 02:31:06 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:VERDUGO HILLS FAMILY YMCAFACILITY NUMBER:
191224046
ADMINISTRATOR:SUZANNE MCMILLENFACILITY TYPE:
850
ADDRESS:6840 FOOTHILL BOULEVARDTELEPHONE:
(818) 352-3255
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:68CENSUS: 44DATE:
11/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:SUZANNE MCMILLENTIME COMPLETED:
02:35 PM
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On 11/22/19, Licensing Program Analyst (LPA) Isabel Ortega was greeted by above facility's Administrator Suzanne McMillen. LPA was at the facility to Amend a Type B deficiency cited on 11/18/19 in regards to a complaint investigation dated 11/18/19. LPA disclosed the purpose of the inspection and was granted entry. Upon entry LPA observed 44 children in care.

Complaint Investigation Type B deficiency (lack of Supervision) page report was Amended, and signature was obtained. Title 22 101216.3 Teacher-Child Ratio was given.

An exit Interview was conducted, a copy of this Amended report, a Notice of Site visit and appeal rights were provided to the Facility Administrator Suzanne McMillen.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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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