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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414470
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:14:51 PM


Document Has Been Signed on 04/18/2024 12:14 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:SHEPHERD OF THE VALLEY LUTHERAN CHURCHFACILITY NUMBER:
197414470
ADMINISTRATOR:SUZANNE LEGUMFACILITY TYPE:
850
ADDRESS:23838 KITTRIDGE STREETTELEPHONE:
(818) 347-6784
CITY:WEST HILLSSTATE: CAZIP CODE:
91307
CAPACITY:104CENSUS: 38DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Suzanne LegumTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA), Susann Sanchez conducted unannounced required annual inspection at the facility. Upon arrival, LPA met with Director, Suzanne Legum who informed LPA that facility just had an annual inspection on 04/15/24. Visit turned into a case management. Director Suzanne Legum gave LPA on a tour of the facility inside and out. Days and hours of operation are Monday through Friday 8:00am to 5:00pm.

LPA observed all required postings in a prominent area. LPA observed 38 children with 11 staff. A walk through of the classroom area was conducted.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director,

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) -98-3350
LICENSING EVALUATOR NAME: Susann SanchezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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