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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495108
Report Date: 03/02/2023
Date Signed: 03/02/2023 12:32:20 PM

Document Has Been Signed on 03/02/2023 12:32 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:GOOD SHEPHERD'S FOLD PRESCHOOLFACILITY NUMBER:
197495108
ADMINISTRATOR:ZURBRUGG, PHIL E.FACILITY TYPE:
850
ADDRESS:1350 W. 25TH STREETTELEPHONE:
(310) 833-3340
CITY:SAN PEDROSTATE: CAZIP CODE:
90732
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
03/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Maria Valin, DirectorTIME COMPLETED:
12:47 PM
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On 03/02/2023 LPA conducted an unannounced visit to the facility above. During todays visit LPA reviewed staff and children records and found that files were missing documentation. LPA issued facility 2 Technical Violations and a LIC 311A Records to be Maintained at The facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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