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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290357
Report Date: 10/05/2020
Date Signed: 10/06/2020 04:03:14 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:GRANDVIEW PRESBYTERIAN CHURCH COMM CHILDRENS CTR.FACILITY NUMBER:
191290357
ADMINISTRATOR:RICKSECKER, E.FACILITY TYPE:
850
ADDRESS:1130 RUBERTA AVETELEPHONE:
(818) 243-1088
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY:68CENSUS: 23DATE:
10/05/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:Roxanne Mullich, Interim DirectorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Thelma Razo conducted an unannounced Case Management - Incident tele-inspection due to COVID-19 and precautionary measures. The call began as a voice call and was switched to a visual call using Google Duo. LPA met with Interim Director Roxanne Mullich. LPA stated the reason of the inspection is due to Unusual Incident which occurred on 10/2/2020 and was self-reported via phone by Interim Director Mullich to Community Care Licensing on the same day. The Unusual Incident was reported within the required time frame. Per report, Parent #1 (P1) informed Staff #1 (S1) that Child #1 (C1) was left in the play area.

During today's tele-inspection, interviews were conducted with 3 staff. LPA toured the facility to include the parking lot, playground and 3 classrooms. LPA observed 23 children and 5 staff at the facility. Staff-child ratio was met.

At this time, no deficiencies are being cited.

Exit interview was conducted with Interim Director Roxanne Mullich. This report along with a copy of the appeal rights will be sent to the director via email with a read receipt or confirmation of receipt of email, which will act as the Applicants/Licensee’s signature. A copy of the signed report will also be sent to the Department.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2020
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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