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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407643
Report Date: 10/07/2021
Date Signed: 10/07/2021 01:14:56 PM

Document Has Been Signed on 10/07/2021 01:14 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WOODLAND HILLS PRIVATE SCHOOLFACILITY NUMBER:
197407643
ADMINISTRATOR:TRACY EWINGFACILITY TYPE:
850
ADDRESS:22555 OXNARD STREETTELEPHONE:
(818) 348-6563
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY: 150TOTAL ENROLLED CHILDREN: 0CENSUS: 112DATE:
10/07/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:47 AM
MET WITH:Vivien FirtaTIME COMPLETED:
01:38 PM
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On 10/07/2021 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced case management visit to process a change of director application. LPA received an application for Alessandra Pinheiro and upon contacting the facility on 10/06/2021 discovered prior applicant was no longer affiliated with the facility. Upon arrival LPA met with applicant Vivien Firta and explained the reason for the visit. Applicant provided LPA with copies of documentation that were mailed to the El Segundo Regional Office.on 10/06/202. LPA reviewed the records and found that the following documentation was missing or incomplete:

Designation of Responsibility (LIC308) need to provide a person other than applicant that will act as director upon the absence of the assigned director.

Center Orientation Certificates: Include recent (within the last two years) Child Care Center Operations and Record keeping Orientation
Online orientation: www.ccld.ca.gov

Verification of experience from prior employer/s. (Letters of Reference must include, job title, dates begin/ended and duties) with an original signature.

Applicant will provide all original documentation to the El Segundo Regional Office by 10/14/2021.

LPA read this report with the applicant (Vivien Firta) and provided her with a copy of this report.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2021
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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