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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419346
Report Date: 09/25/2019
Date Signed: 09/25/2019 03:42:18 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:CHILDREN'S COLL INC/HOPE MEMORIAL CDC, THEFACILITY NUMBER:
197419346
ADMINISTRATOR:BACH, ROCIOFACILITY TYPE:
850
ADDRESS:3401 SOUTH SOMERSET DRIVETELEPHONE:
(310) 733-4388
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY:30CENSUS: 11DATE:
09/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Michele DixonTIME COMPLETED:
04:00 PM
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On 09/25/19, Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a Case Management inspection.

LPA reviewed the records for staff present at the time of inspection to verify qualifications. LPA observed Director, Michele Dixon, Teacher, Shavonne Gladney and TA Patricia Anguiano present with 11 children in care.

LPA reviewed staff records and found them to be complete.

No deficiency cited.

Copy of report and Notice of Site Visit issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2019
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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