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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890355
Report Date: 10/18/2022
Date Signed: 10/18/2022 11:56:37 AM


Document Has Been Signed on 10/18/2022 11:56 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:GLEDHILL STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191890355
ADMINISTRATOR:BORQUEZ, MARTHAFACILITY TYPE:
850
ADDRESS:16058 GLEDHILL ST.TELEPHONE:
(818) 895-2491
CITY:SEPULVEDASTATE: CAZIP CODE:
91343
CAPACITY:119CENSUS: 57DATE:
10/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Carolina Gomez, PrincipalTIME COMPLETED:
12:00 PM
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On 10/18/2022, Licensing Program Analyst (LPA) Sabrina Martinez conducted an unannounced inspection at Gledhill Street Early Childhood Education Center located at 16058 Gledhill St., North Hills, CA 91343, for the purpose of following up on the self reported unusual incident that occurred at the facility on 07/05/2022. The SCAR Report dated 09/28/2022 was faxed to the El Segundo Child Care North Office on 09/29/2022.

LPA met with Principal Carolina Gomez and discussed the purpose of the visit.

During today’s visit, LPA collected and reviewed the following records: Child Care Facility Roster (LIC 9040), Pupil Health Exclusion, Child #1's Patient Clinical Report, and SCAR report dated 09/28/2022. LPA observed completed and current Mandated Reporter Training Certificate for facility staff. LPA also conducted an interview with Principal, Staff #1, and Child #1.

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



An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2022
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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