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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015514
Report Date: 05/30/2023
Date Signed: 05/30/2023 01:24:27 PM


Document Has Been Signed on 05/30/2023 01:24 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:BPUSD - NORTH PARK HIGH SCHOOLFACILITY NUMBER:
198015514
ADMINISTRATOR:JERRI SANDELLFACILITY TYPE:
830
ADDRESS:4600 N. BOGART AVENUETELEPHONE:
(626) 962-3311
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:40CENSUS: 6DATE:
05/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Nancy LopezTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 03/09/2023. LPA met with Education Program Manager, Nancy Lopez. LPA observed 06 children present with 02 staff at the time of arrival.

The incident that occurred on March 09, 2023 was reported to the Department on March 09, 2023 via email, within the required 24 hours of occurrence as required.

LPA conducted interviews and obtained documentation during this visit. Due to insufficient information at this time, a follow up visit may be conducted at a later date to conduct additional interviews.

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.

There are no citations being issued today.

Exit interview was conducted with Nancy Lopez. Appeal rights explained & provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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