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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593822
Report Date: 07/12/2019
Date Signed: 07/12/2019 01:24:35 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:CHARTER OAK DAY SCHOOL-INFANT CENTERFACILITY NUMBER:
191593822
ADMINISTRATOR:BARRAZA, SARAHFACILITY TYPE:
830
ADDRESS:20350 E. CIENEGA AVE.TELEPHONE:
(626) 967-6611
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:15CENSUS: 2DATE:
07/12/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Viviann IvoryTIME COMPLETED:
10:30 AM
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Cynthia Reyes, Licensing Program Analysts (LPA) conducted an unannounced Case Management Inspection for the purpose of inspecting and measuring the facility for a room change and capacity determination. Licensee is seeking to provide care for 15 infants in the new class room. LPA met with site manager Viviann Ivory, who guided analyst on a tour of the facility. The infant program operate Monday through Friday 6:30 AM - 6:00 PM. Viviann Ivory submitted a letter on this date to the LPA stating she has decided not to move forward with the Infant room change and is withdrawing the application at this time.

Exit interview was conducted with site manager Viviann Ivory. Appeal rights explained.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019
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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