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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004790
Report Date: 01/13/2020
Date Signed: 01/13/2020 02:06:57 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. JOHN OF GOD PRE-KFACILITY NUMBER:
198004790
ADMINISTRATOR:TRACIE GUTIERREZFACILITY TYPE:
850
ADDRESS:13817 PIONEER BLVD.TELEPHONE:
(562) 863-5721
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:20CENSUS: 0DATE:
01/13/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tracie Gutierrez, DirectorTIME COMPLETED:
02:10 PM
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An unannounced Required Inspection was conducted on this day by Licensing Program Analyst (LPA) Lucero. Upon arrival to the facility, Director stated that they facility is not operating since there are no children currently enrolled. LPA toured the preschool classroom and verified that there were no children present.

LPA provided and received the Inactive Status Form that was filled out during inspection. Facility is requesting to be placed on Inactive Status until 07/01/2020. Director understands that the facility may not operate while on Inactive Status.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 01/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2020
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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