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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 10:17:54 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:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:39 AM
MET WITH:Andrea Penn, DirectorTIME COMPLETED:
10:30 AM
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***Report Amended to add signatures on LIC809D pages and to change allegation from Substantiated to Unsubstantiated.

Licensing Program Analyst (LPA), Shandra Powell conducted a Case Management Visit to Amend forms and obtain signatures on a completed Complaint Investigation. Upon arrival LPA was greeted by Director Andrea Penn. During the investigation on 03/05/2020 the LIC 809D pages were not signed also the Complaint Control Number: 30-CC-20200211161607 was Substantiated in error. The correct finding for the allegation should had shown Unsubstantiated during the initial inspection on 03/05/2020.

LPA advised Director to continue to read all updates emails from Community Care Licensing Division. The Community Care Licensing Divison has released a new Provider Information Notice: PIN 20-05-CCLD for Coronavirus Disease 2019 (COVID-19) - Related Questions The established dedicated e-mail address to asked questions regarding the virus is CCLCOVID-19INFO@dss.ca.gov. When sending a question to the e-mail address, please specify the facility type in the subject line and/or the body of the e-mail.

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 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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