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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494448
Report Date: 09/18/2024
Date Signed: 09/18/2024 02:51:40 PM


Document Has Been Signed on 09/18/2024 02:51 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:LE PETIT GAN WEST HOLLYWOOD LLCFACILITY NUMBER:
197494448
ADMINISTRATOR:KHALILI, SOPHIE BOTBOLFACILITY TYPE:
850
ADDRESS:968 NORTH DOHENY DRTELEPHONE:
(310) 866-0570
CITY:WEST HOLLYWOODSTATE: CAZIP CODE:
90069
CAPACITY:30CENSUS: 8DATE:
09/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Assistant Director / Ziporah TrulyTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Case Management Visit to this facility. Upon arrival, LPA met with Assistant Director / Ziporah Truly, who guided LPA on a tour of
the facility. There were 3 children with 1 staff observed present in the preschool program and 5 children with 1 staff observed present in the toddler program.

LPA Katrdzhyan discovered that the facility failed to report changes in the plan of operation that affect services to children. During a visit conducted at this facility on 7/11/24, LPA observed the facility utilizing the main room (near the main entrance) for a "Mommy and Me" class. LPA observed 4 children and 4 mothers during the class. Per Assistant Director / Ziporah Truly, it was disclosed that the facility failed to report changes in the plan of operation to CCL, per Title 22 Reporting Requirements, Section 101212.

The Assistant Director understands the importance of reporting requirements and will inform Community Care Licensing (CCL) in the event the facility plans to host future "Mommy and Me" classes by providing an update to the plan of operation and informing CCL.

An Advisory Note - Technical Assistance was issued during today's visit stating that Title 22 Regulations Section 101212(e)(4) was discussed with Assistant Director / Ziporah Truly, regarding Reporting Requirements.

The Notice of Site Visit was provided and must remain posted for 30 days during the hours of operation after
each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty
of $100.00.

Exit interview was conducted with Ziporah Truly and Appeals Rights provided.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Joe KatrdzhyanTELEPHONE: (424) 301-3049
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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