<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011002
Report Date: 03/01/2022
Date Signed: 03/01/2022 02:37:50 PM


Document Has Been Signed on 03/01/2022 02:37 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LOS ANGELES ADVENTIST ACADEMYFACILITY NUMBER:
198011002
ADMINISTRATOR:JACQUELINE GALBREATHFACILITY TYPE:
850
ADDRESS:846 E.EL SEGUNDO BOULEVARDTELEPHONE:
(323) 743-8818
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:40CENSUS: 16DATE:
03/01/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Cassandra Hudson- Johnson, Acting DirectorTIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced ase management inspection on 3/1/22. LPA arrived at the facility at 1:30pm. LPA met with Cassandra Hudson-Johnson, Acting Director. LPA toured the facility at 1:34pm. LPA observed, 16 children, and 1 staff member in addition to Acting Director present during the inspection.
During an interview conducted with Investigator from Community Care Licensing Investigations Branch (IB), an allegation of personal rights violation was reported. IB investigator conducted interviews with Child #1 and a witness.

LPA conducted interviews with the director, facility staff, children and witnesses. Although staff #1 was observed holding the hands of child #1 and shaking them, interviews conducted did not corroborate the allegation that child #1’s personal rights were violated while in care.

LPA provided consultation to Licensee regarding personal rights and reporting requirements. Facility records were reviewed.



No deficiencies are being cited in areas observed.
This report was reviewed with Cassandra Hudson-Johnson, facility representative and a copy was provided.

The Notice of Site Visit (LIC 9213) – 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.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1