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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008821
Report Date: 04/13/2022
Date Signed: 04/13/2022 02:54:52 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/13/2022 02:54 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:AMISTAD PRESCHOOLFACILITY NUMBER:
198008821
ADMINISTRATOR:ANAHIT SHMAVONYANFACILITY TYPE:
850
ADDRESS:2037 N. LINCOLN PARK AVE.TELEPHONE:
(323) 441-8718
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 48TOTAL ENROLLED CHILDREN: 23CENSUS: 0DATE:
04/13/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Lupe Granados TIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Judy Mora conducted a Case Management Annual Continuation inspection on this date. Inspection was conducted at the Licensee's main office at 3845 Selig Place, LA, CA 90031. LPA met with Lupe Granados, Program Director.

The purpose of this visit is to review staff files for the 1 Year Required inspection that was conducted at the facility on 04/04/2022.

Staff Records were reviewed to ensure the following are present: Staff qualifications, proof of immunization’s, current Pediatric First Aid & CPR certification, TB Clearance or Risk Assessment, LIC 503 Health Screening Report, LIC 508 Criminal Record Statement, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Mandated Reporter Certificate and the LIC 9052 Notice of Employee’s Rights.

LPA observed all staff files to be complete.

Exit interview was conducted with Lupe Granados.
Claudia Guangorena
Judy Mora
DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2022
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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