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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408359
Report Date: 09/29/2021
Date Signed: 09/29/2021 02:08:11 PM

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:ST. MEL PRESCHOOLFACILITY NUMBER:
197408359
ADMINISTRATOR:CLAUDIA POWELLFACILITY TYPE:
850
ADDRESS:5130 SERRANIATELEPHONE:
(818) 340-3180
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:120CENSUS: 59DATE:
09/29/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Meghan EyerTIME COMPLETED:
02:14 PM
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On 09/29/2021 Licensing Program Analyst (LPA) conducted an unannounced case management visit to qualify a change in director. LPA met with Meghan Eyer (new director applicant). LPA reviewed all documentation provided and found the following documents to be missing or incomplete:

Board of Resolution to authorize the filling of the application and to name the authorized person.
Verification of Experience (letters of reference)

The facility will shall provide this documentation by 10/04/2021 to the Regional Office
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Laticia S ThompsonTELEPHONE: (424) 301-3048
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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