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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414470
Report Date: 01/15/2020
Date Signed: 01/15/2020 04:06:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHEPHERD OF THE VALLEY LUTHERAN CHURCHFACILITY NUMBER:
197414470
ADMINISTRATOR:SHIRLEY BELLMANFACILITY TYPE:
850
ADDRESS:23838 KITTRIDGE STREETTELEPHONE:
(818) 348-8343
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:80CENSUS: 20DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Claudia Zavala Lanz, Director AssistantTIME COMPLETED:
04:10 PM
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On 01/15/2020 at 03:00PM, Licensing Program Analyst (LPA) Denise Miranda arrived at Shepherd the Valley Lutheran Church for the purpose of delivering the investigation findings of the self-reported unusual incident with date and time unclear that parent#2 stated child#1 pulled down and hit/tapped the private area of the child#2. The unusual incident was reported via phone call to the El Segundo Regional Child Care Office on 12/06/2019).

Upon arrival, LPA met with Director Assistant Ms. Claudia Zavala Lanz and informed the nature of the visit. There were a total of 20 children being supervised by 5 teachers.

This agency has investigated the incident. Based upon the evidence obtained throughout the course of the investigation which include observations at the facility, interview with relevant parties, and records review, we have concluded there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, this allegation has been determined unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.


An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Claudia Zavala Lanz, Director Assistant.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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