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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197403646
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:26:18 PM

Document Has Been Signed on 09/28/2023 12:26 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ST. ELISABETH PRESCHOOLFACILITY NUMBER:
197403646
ADMINISTRATOR:LEEHAY, EMMAFACILITY TYPE:
850
ADDRESS:6635 TOBIAS AVE.TELEPHONE:
(818) 779-1766
CITY:VAN NUYSSTATE: CAZIP CODE:
91405
CAPACITY: 50TOTAL ENROLLED CHILDREN: 12CENSUS: 11DATE:
09/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:37 AM
MET WITH:Mary Harrington- Facility RepresentativeTIME COMPLETED:
12:40 PM
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On 9/28/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced case management visit. LPA Ornelas met with Mary Harrington - Facility Representative. LPA toured the facility and observed 11 children in care being supervised by 1 staff.

The Purpose of the inspection is to clear the citation issued, as Director is now fingerprinted, and to issue the correct civil penalty form, as the previous one was incorrect.

Exit interview was conducted and a copy of this report was provided to Mary Harrington- Facility Representative
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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