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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192002562
Report Date: 11/12/2021
Date Signed: 11/12/2021 11:23:19 AM

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:ANGELINA PRESCHOOLFACILITY NUMBER:
192002562
ADMINISTRATOR:PEREZ, ADRIANAFACILITY TYPE:
850
ADDRESS:1336 ANGELINA STREET #108TELEPHONE:
(213) 481-0227
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:73CENSUS: 34DATE:
11/12/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Adriana Perez TIME COMPLETED:
11:40 PM
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 11/03/21. LPA met with Adriana Perez. LPA was guided on a tour of the facility at approximately 9:10 AM.

LPA conducted interviews and obtained documentation during this visit. LPA also visually observed child #1 on several instances through this visit.

Based on all information obtained on this date and interviews conducted, there is no information to support that any child's personal rights were violated. There were no disclosures made during interviews. There is no follow-up is necessary regarding the incident. There were no deficiencies observed in regards to today's visit.
LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Adriana Perez, Director. Appeal rights explained & provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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