<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419528
Report Date: 03/06/2023
Date Signed: 03/06/2023 05:36:56 PM

Document Has Been Signed on 03/06/2023 05:36 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:JUS KIDS ACADEMYFACILITY NUMBER:
197419528
ADMINISTRATOR:VITELA, MARIANAFACILITY TYPE:
850
ADDRESS:11211 WESTERN AVETELEPHONE:
(323) 777-0704
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: 7DATE:
03/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:ESMA ITZALE, TEACHERTIME COMPLETED:
05:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/06/2023, LPA Clayton arrived at the facility unannounced to conduct a Case Management inspection. LPA Clayton was greeted by Teacher Esma Itzale. LPA Clayton toured the facility for a Health and Safety inspection and observed 7 preschool children in care, being supervised by 1 teacher.

The reason for the visit to the facility is to return the education and experience documents for the staff at the CCC, taken for review and copies on 03/01/2023.

Exit interview conducted and report was reviewed with teacher Esma Itzale. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1