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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017599
Report Date: 10/26/2021
Date Signed: 10/26/2021 11:20:29 AM

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:PACIFIC CLINICS LEXINGTON HEAD STARTFACILITY NUMBER:
198017599
ADMINISTRATOR:AZO DEUKMEJIANFACILITY TYPE:
850
ADDRESS:735 E. LEXINGTON DR.TELEPHONE:
(818) 552-7372
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:71CENSUS: 40DATE:
10/26/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Azo Deukmejian, Site SupervisorTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Lissete Gonzalez conducted a case management inspection due to an incident that occurred on 05/26/21. Upon arrival, LPA met with Site Supervisor, Azo Deukmejian. There were forty (40) children present.

The incident that occurred on 05/26/21 was reported to the Department via telephone on 05/27/21 via telephone and on 06/02/21 the written report was received via email. The facility reported the incident to the Department in a timely manner. The Unusual Incident which was reported was an allegation of a possible violation of Personal Rights of a Preschool child.

This agency has investigated the allegation of a personal rights violation. We have found that based on all information obtained and interviews conducted no follow-up is necessary regarding the incident. There is not a preponderance of evidence to prove the alleged violation did or did not occur.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Site Supervisor, Azo Deukmejian.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2021
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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