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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870884
Report Date: 05/12/2022
Date Signed: 05/12/2022 03:15:09 PM


Document Has Been Signed on 05/12/2022 03:15 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:SHENANDOAH EARLY EDUCATION CENTERFACILITY NUMBER:
191870884
ADMINISTRATOR:COLLINS, CAROLFACILITY TYPE:
850
ADDRESS:8861 BEVERLYWOOD ST.TELEPHONE:
(310) 838-7328
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY:115CENSUS: 23DATE:
05/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Acting Lead Teacher, Elaine Eatman TIME COMPLETED:
03:30 PM
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On 5/12/2022 Licensing Program Analysts (LPA) Dalicia Adkins conducted an unannounced case management visit. LPA Adkins was greeted by office staff, LPA was informed that principal was not available. LPA met with acting lead teacher, and was granted entry into the facility. LPA informed acting lead teacher about the purpose of visit and LPA was provided with a tour of the facility. LPA observed 23 children napping and 13 teachers.

The purpose of this visit to investigate the Self Reported Unusual Incident (LIC 624) Reported to Community Care Licensing on 3/25/2022.

Today’s visit LPA collected and reviewed the following records: Children’s Roster, Personnel Roster, Activity Schedule and Children File. LPA conducted classroom observations and interviewed staff.

Based on the information gathered it was determined that this self reported unusual incident needs further investigation.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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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