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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609574
Report Date: 12/21/2022
Date Signed: 12/22/2022 10:15:11 AM

Document Has Been Signed on 12/22/2022 10:15 AM - 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:CHILDREN COMMUNITY ACADEMYFACILITY NUMBER:
191609574
ADMINISTRATOR:ETHEL L. HENSONFACILITY TYPE:
850
ADDRESS:4729 W. SLAUSON AVE.TELEPHONE:
(323) 290-0022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 19DATE:
12/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Ethel HensonTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), V. Wheatley conducted an unannounced Plan of Correction inspection at 11am to verify that the corrections for the deficiencies cited on December 8, 2022 were corrected.

LPA met with licensee and director Ethel Henson and discussed the purpose of the inspection. LPA toured the premises and observed 19 children on the premises being properly supervised by staff.

The facility is operating within proper supervision and ratios.

LPA did not observe any adults on the premises without a Criminal Record Clearance.

There were no violations observed today.

Exit interview conducted and report will provided via email to Ms. Henson due to technical difficulties.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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