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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570644
Report Date: 10/23/2019
Date Signed: 10/23/2019 11:52:30 AM

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:EAST LA COLLEGE CAMPUS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191570644
ADMINISTRATOR:SIMONE, MICHAELFACILITY TYPE:
850
ADDRESS:1301 AVENIDA CESAR CHAVEZTELEPHONE:
(323) 265-8717
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:180CENSUS: 75DATE:
10/23/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:28 AM
MET WITH:Marcia Cagigas, DirectorTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Mireya Garcia and Jose Guzman conducted an unannounced visit to address annual random inspection visit on 10/22/2019. LPA Garcia was unable to complete electronic report due to technical difficulties (consistency check). LPA met with Marcia Cagigas, Director, who guided analyst on a tour of the facility. Census was taken.

There were no deficiencies cited during today’s inspection.

Exit interview was conducted with Marcia, Director, and Jacqueline Zavala, Assistant Director including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

End of Report--------------------------------

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2019
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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