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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501150
Report Date: 11/17/2023
Date Signed: 11/17/2023 04:37:56 PM


Document Has Been Signed on 11/17/2023 04:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WHITTIER YMCA SCHOOL AGE SITEFACILITY NUMBER:
191501150
ADMINISTRATOR:SUSETTE SEPULVEDAFACILITY TYPE:
840
ADDRESS:12510 E. HADLEY ST.TELEPHONE:
(562) 306-5989
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:105CENSUS: DATE:
11/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Executive Director of Operations, Soretta WalkerTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) conducted a visit on this day to follow up on the Decision and Order effective November 20, 2023, for Eric Williams.

Executive Director of Operations, Soretta Walker, stated on this day that Eric Williams has never been employed at this facility. LPA provided copies of the Decision and Order and Accusation to the facility.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023
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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