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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890457
Report Date: 08/25/2023
Date Signed: 08/25/2023 03:15:12 PM


Document Has Been Signed on 08/25/2023 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:TOLUCA LAKE EARLY EDUCATION CENTERFACILITY NUMBER:
191890457
ADMINISTRATOR:KAZARIAN, VIKENFACILITY TYPE:
850
ADDRESS:4915 STROHM AVETELEPHONE:
(818) 980-0925
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:119CENSUS: 46DATE:
08/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Nina Jones, Head Teacher-DesgineeTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incident that occurred on 04/07/2022. LPA arrived at the facility at 2:10PM and met with Nina Jones, Head Teacher-Desginee, who guided LPA on a tour of the facility. There were 46 children and 13 staff present upon arrival.

The purpose of the visit was to follow up on a self reported incident.

The incident that occurred on 04/07/2022, was reported to the Department on 04/13/2022, via fax. The facility did not report the Unusual Incident to the Department within the required 24 hours of occurrence.

During the investigation by the Department, interviews were conducted, records were reviewed, and other pertinent information and documents were also obtained.

Based upon documentation received and interviews conducted, the Department concluded that the investigation did not have sufficient evidence to determined that the personal rights of Child #1 may or may not have been violated.

There were no deficiencies cited during today’s inspection.

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

Exit interview conducted and report was reviewed with Nina Jones, Head Teacher Desginee.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/25/2023
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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