<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191888888
Report Date: 02/06/2023
Date Signed: 02/06/2023 04:15:44 PM


Document Has Been Signed on 02/06/2023 04:15 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LOS ANGELES UNIFIED SCHOOL DISTRICT SUBSTITUTESFACILITY NUMBER:
191888888
ADMINISTRATOR:BARBARA GUTIERREZFACILITY TYPE:
850
ADDRESS:333 S. BEAUDRY AVE. 27TH FLOORTELEPHONE:
(213) 241-1000
CITY:LOS ANGELESSTATE: CAZIP CODE:
90017
CAPACITY:100CENSUS: DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:14 PM
MET WITH:TIME COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This is a dummy file created by DSS to monitor LAUSD collateral, office and some case management visits. This file also is being used for some of the LAUSD consolidated billing purposes.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1