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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570889
Report Date: 08/02/2019
Date Signed: 08/02/2019 03:39:12 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILL ROGERS CHILDREN'S CENTERFACILITY NUMBER:
191570889
ADMINISTRATOR:NAOMI MOOREFACILITY TYPE:
850
ADDRESS:11250 DUNCANTELEPHONE:
(310) 603-1544
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:71CENSUS: 36DATE:
08/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Gisele Ochoa, ECE Program Specialist TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced case management inspection due to an incident that was reported to the department on 07/22/2019. LPA met with Gisele Ochoa, ECE Program Specialist.

The school became aware of the incident on 07/22/2019 and reported to the Department on 07/22/19 via telephone. The facility reported this incident to the Department within the required 24 hours.

During inspection, LPA conducted interviews however LPA was unable to interview all staff. All permanent staff were in a Staff Development Training. Due to insufficient information being available at this time, a follow up visit will be required at a later date.

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.

Exit interview was conducted with Gisele Ochoa, ECE Program Specialist.

Appeal Rights were given and explained.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3366
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2019
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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