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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402404
Report Date: 05/30/2023
Date Signed: 05/30/2023 10:30:54 AM

Document Has Been Signed on 05/30/2023 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ONEGENERATIONFACILITY NUMBER:
197402404
ADMINISTRATOR:VARDANYAN, KRISTINEFACILITY TYPE:
830
ADDRESS:17400 VICTORY BLVD.TELEPHONE:
(818) 708-6377
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 60TOTAL ENROLLED CHILDREN: 43CENSUS: 37DATE:
05/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Director- Adena Amalian and Assistant Director Katherine NathanTIME COMPLETED:
10:40 AM
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On 05/30/2023, Licensing Program Analyst's (LPA) Suzette Ornelas conducted an unannounced case management inspection for the purpose of amending a report.

Upon arrival LPA was greeted by Director, Adena Amalian and Assistant Director Katherine Nathan and observed 37 children and 14 adults.

During todays visit, LPA amended a report and obtained signatures.

Exit interview was conducted. Notice of Site Visit provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
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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