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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600175
Report Date: 03/02/2020
Date Signed: 03/02/2020 11:54:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COVENANT PRESBYTERIAN CHURCH PRESCHOOLFACILITY NUMBER:
191600175
ADMINISTRATOR:SULTAN, KATHLEENFACILITY TYPE:
850
ADDRESS:6323 WEST 80 STREETTELEPHONE:
(310) 670-5758
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:74CENSUS: DATE:
03/02/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Kathleen SultanTIME COMPLETED:
09:00 AM
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On March 2nd, 2020 at 8:30 am, Licensing Program Analyst Lisa Rios went to Covenant Preschool in Westchester to conduct a Case Management visit regarding an incident that took place on 1/17/2020 involving a student that broke his leg.
Director Kathleen Sultan informs LPA Rios that LPA Starks was at the center on February 28th, 2020 to conduct the Case Management inspection regarding the same incident.
LPA Rios is not able to see the report as this report is being conducted offline.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2020
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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