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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
191870874
Report Date:
06/16/2022
Date Signed:
06/16/2022 03:45:23 PM
Document Has Been Signed on
06/16/2022 03:45 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 CENTER DR 200B
MONTEREY PARK
,
CA
91754
FACILITY NAME:
MOUNT ST. MARY'S CHILD DEVELOPMENT CENTER
FACILITY NUMBER:
191870874
ADMINISTRATOR:
WENDY GALAN
FACILITY TYPE:
850
ADDRESS:
10 CHESTER PLACE
TELEPHONE:
(213) 477-2977
CITY:
LOS ANGELES
STATE:
CA
ZIP CODE:
90007
CAPACITY:
74
CENSUS:
25
DATE:
06/16/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
03:36 PM
MET WITH:
Wendy Galan, Program Director
TIME COMPLETED:
03:59 PM
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Print the Technical Violations and complete the inspection tool.
SUPERVISOR'S NAME:
Karen Chambers
TELEPHONE:
(323) 981-3368
LICENSING EVALUATOR NAME:
Mayra Rivera
TELEPHONE:
(323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE:
06/16/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/16/2022
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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