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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:39:16 PM


Document Has Been Signed on 02/22/2023 01:39 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:GEORGETTE BRADLEYFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:55CENSUS: 33DATE:
02/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Georgette BradleyTIME COMPLETED:
01:35 PM
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On 02/222023 Licensing Program Analyst ( LPA) Doris Whitmore conducted an attempted unannounced Case Management for the purpose of incident Report( UIR) that occurred on 01/25/2023. At the time of the visit there was a total of thirty three children and eleven staff, Upon arrival, LPA met with Site Supervisor Georgette Bradley and informed the nature of the visit. LPA was following up from last visit on 02/16/2023 to continue interviews child was sleep and leaves at 1:30p.m. teacher was absent. LPA Whitmore will come an do another unaanounced visit to continue with interviews. An exit interview was conducted with Site Supervisor Georgette Bradley. A copy of this report and Notice of Site Visit was given to Georgette Bradley.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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