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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413678
Report Date: 09/06/2022
Date Signed: 09/06/2022 10:45:33 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/06/2022 10:45 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:OUR LADY OF LOURDES EARLY-FIVESFACILITY NUMBER:
197413678
ADMINISTRATOR:DAVIES, VIRGINIAFACILITY TYPE:
850
ADDRESS:18437 SUPERIOR STREETTELEPHONE:
(818) 349-0245
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:23CENSUS: 0DATE:
09/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Kris Brough, School Principal.TIME COMPLETED:
11:00 AM
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On 09/06/2022, Licensing Program Analyst (LPA) Suzette Ornelas conducted an annual random visit and spoke with Kris Brough, School Principal.

Per record review from LPA, license was put on inactive status in 2018 and fees are not current.

Per, Kris Brough, School Principal, it has been 8 years since the program was last operating and they do not plan on reopening. Kris Brough, School Principal further stated that he would like to close this license. Contact email provided: kbrough@ollnr.org and a declaration to close facility license 197413678 will be emailed to LPA via email.

Exit interview conducted.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2022
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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