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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603677
Report Date: 03/12/2020
Date Signed: 03/12/2020 10:45:45 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:HOLY TRINITY LUTHERAN CHILD CARE CENTERFACILITY NUMBER:
191603677
ADMINISTRATOR:ANDREA PENNFACILITY TYPE:
850
ADDRESS:9300 CRENSHAW BLVDTELEPHONE:
(323) 757-4850
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:85CENSUS: 43DATE:
03/12/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Andrea Penn, DirectorTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A and B deficiencies cited on 03/05/2020 have been cleared. LPA met with Andrea Penn, Director.

· Care and Supervision, including visual supervision was observed.
· Reporting Requirements
· Sign in and Sign Out Sheets


Director provided all necessary forms and documents to clear above deficiencies.

At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

LPA cleared deficiencies on this date and provided a copy of the Licensing Report to Andrea Penn, Director. LPA issued POC clearance letters 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 Andrea Penn, Director, Appeal Procedures given and explained.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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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