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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019499
Report Date: 01/17/2020
Date Signed: 01/17/2020 03:07:34 PM

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:PLAY PRESCHOOLFACILITY NUMBER:
198019499
ADMINISTRATOR:GABRIEL ROSSFACILITY TYPE:
830
ADDRESS:2828 GLENDALE BLVDTELEPHONE:
(323) 664-8494
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:50CENSUS: 0DATE:
01/17/2020
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Gabriel RossTIME COMPLETED:
03:00 PM
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An Office meeting was conducted on this date with Director, Gabriel Ross. In attendance are Licensing Program Analyst (LPA) Janeth Chavez, Licensing Program Manager (LPM) Trevino Cochran and Regional Manager (RM) Deborah Ajao.

The purpose of the meeting is to review facility information. There are no citations given on this day in connection to the meeting. Exit interview conducted with Gabriel Ross. A copy of this report was provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 01/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2020
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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