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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494300
Report Date: 08/22/2019
Date Signed: 08/22/2019 04:55:16 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:LITTLE STARSFACILITY NUMBER:
197494300
ADMINISTRATOR:LAURA CARDENASFACILITY TYPE:
850
ADDRESS:2720 W. SLAUSON AVETELEPHONE:
(323) 421-2662
CITY:LOS ANELESSTATE: CAZIP CODE:
90043
CAPACITY:20CENSUS: DATE:
08/22/2019
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:TIME COMPLETED:
12:00 PM
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On August 22nd, 2019 Licensing Program Analyst Lisa Rios while reviewing the Little Stars facility file, the following changes needed were identified:
The Licensee's Name on the Facility Licensing needs to be changed to Crystal Stairs INC. In addition,Crystal Stairs INC is being asked to submit a board resolution agreeing to the application and operation of the facility Little Stars located at 2720 W. Slausen Ave, Los Angeles Ca. 90043.

This facility will be operating under Title 22 and Title 5 regulations.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2019
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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