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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603677
Report Date: 02/03/2022
Date Signed: 02/03/2022 12:57:35 PM


Document Has Been Signed on 02/03/2022 12:57 PM - It Cannot Be Edited

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:KORY HIGGINSFACILITY TYPE:
850
ADDRESS:9300 CRENSHAW BLVDTELEPHONE:
(323) 757-4850
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:85CENSUS: 28DATE:
02/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Kory Higgins, DirectorTIME COMPLETED:
12:16 PM
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On 02/03/2022 Licensing Program Analyst (LPA), Shandra Powell conducted an unannounced Plan of Corrections Visit (POC). An initial 1 year required inspection was made on 01/28/2022. Census were taken.

The following deficiencies that were previously cited on a LIC 809D during the 1 year required inspection have all been cleared:

1. All children's required forms are complete and signed in their files.
2. LPA viewed document created for Safe Sleep "15 min" Log for all children under two years of age.

The facility is within compliance of Title 22 Div. 12 of the California Code of Regulations.

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 Kory Higgins, Director, Letter of Deficiencies Cleared, Report, and Appeal Rights were provided during inspection.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2022
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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