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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494344
Report Date: 03/11/2025
Date Signed: 03/11/2025 03:01:26 PM

Document Has Been Signed on 03/11/2025 03:01 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:INGLEWOOD USD-PAYNE STATE PRESCHOOLFACILITY NUMBER:
197494344
ADMINISTRATOR/
DIRECTOR:		DR. BRIAN COFFEYFACILITY TYPE:
850
ADDRESS:215 W. 94TH STREETTELEPHONE:
(310) 419-2691
CITY:INGLEWOODSTATE: CAZIP CODE:
90301
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 1DATE:
03/11/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Linda AndersonTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 03/11/2025 Licensing Program Analyst, LPA, Tyra Chavies conducted an unannounced Case Management-other visit for the purpose of amending a report from 10/24/2024. During the visit, LPA Chavies observed 1 child in care being supervised by 3 Staff members.

On 10/24/2024 LPA Chavies conducted an unannounced 3 Year Required at Inglewood USD-Payne State Preschool. During the inspection, LPA Chavies reviewed Guardian and observed Staff #1 not associated to the facility. LPA cited a Type A with a civil penalty.

On 03/11/2025 LPA Chavies met with Lead Teacher, Linda Anderson, to obtain a wet signature on both copies of the Amended Report. LPA has left a signed copy with Lead Teacher.

An exit interview was conducted with Lead Teacher, Linda Anderson.

A copy of this report was read and given to Lead Teacher as well as LIC 9213 (Notice of Site Visit) LIC 9213 is required to be posted for 30 days.
Karren StarksTELEPHONE: (424) 301-3069
Tyra ChaviesTELEPHONE: 424-301-3204
DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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