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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603677
Report Date: 05/17/2019
Date Signed: 05/17/2019 04:31:31 PM

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:HOLY TRINITY LUTHERAN CHILD CARE CENTERFACILITY NUMBER:
191603677
ADMINISTRATOR:PRINCESS FOSTERFACILITY TYPE:
850
ADDRESS:9300 CRENSHAW BLVDTELEPHONE:
(323) 757-4850
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:85CENSUS: DATE:
05/17/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:38 PM
MET WITH:Jazmin GrahamTIME COMPLETED:
04:02 PM
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Licensing Program Analyst (LPA) Shandra Powell conducted a Plan of Correction (POC) inspection to ensure that the citation issued on 05/09/19 has been corrected. LPA met with Jazmin Graham, Assistant Director who guided analyst through the facility and also onto the playground observed corrected deficiencies.

Based on LPA's observation the Type A deficiency issued on 05/09/19 has been cleared.

Director also corrected the Type B deficiencies cited on 05/09/19.

At this time, the facility is in compliance. Therefore, no deficiencies are being cited.

LPA cleared deficiencies on this date and provided a copy of the Licensing Report to Jazmin Graham, Assistant Director. LPA issued POC clearance letter during the visit.

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 Jazmin Graham, Assistant Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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