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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191803046
Report Date: 03/15/2023
Date Signed: 03/15/2023 02:38:58 PM


Document Has Been Signed on 03/15/2023 02:38 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LOS ANGELES FAMILY SCHOOLFACILITY NUMBER:
191803046
ADMINISTRATOR:LISSETT AVILAFACILITY TYPE:
850
ADDRESS:2646 GRIFFITH PARK BOULEVARDTELEPHONE:
(323) 663-8049
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:92CENSUS: 62DATE:
03/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director, Lissett AvilaTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced POC (Plan of Correction) inspection to ensure that the Type A & B deficiencies cited on 02/07/2023 have been cleared. LPA met with Lissett Avila, Director who guided analyst on a tour of the facility both indoors and outdoors. There were 62 children present during this inspection. The following has been observed:
  • LPA review staff records for Staff #3 and Staff #4 and observed immunization's are on file.
  • LPA review staff records for Staff #2 and Staff #9 and observed completion certificates for Child Care Provider training AB1207 on file.
  • LPA review completion of EMSA Health, Safety, Nutrition, & Lead Poisoning on file for Admin.
  • LPA review staff records of Health Screening Reports LIC503 on file for Staff #1, #3 and #6.
  • LPA review child’s #1, #2 and #3 records and observed signed physician & parent required documentation on file for the administration of medication.
  • LPA observed child #1’s medication Epinephrine Injection with expiration date of 01/2024.

At this time, the licensee 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 Lissett Avila, Director. LPA issued POC clearance letter during the visit.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Lissett Avila.
REPORT ENDS HERE PAGE 1 OF 1.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023
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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