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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495126
Report Date: 10/26/2022
Date Signed: 10/26/2022 03:36:49 PM

Document Has Been Signed on 10/26/2022 03:36 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:FIRST FLIGHT BY LA PETITEFACILITY NUMBER:
197495126
ADMINISTRATOR:MIRIAM KERAMATIFACILITY TYPE:
850
ADDRESS:9320 LINCOLN BLVDTELEPHONE:
(310) 568-2743
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 48TOTAL ENROLLED CHILDREN: 13CENSUS: 18DATE:
10/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:LaShawnda Keys - directorTIME COMPLETED:
02:50 PM
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On 10/25/2022 Licensing Program Analyst Jillinda Chandler made an announced visit for the purpose of conducting a case management - other, to an amended report signed and delivered. LPA met with LaShawnda Keys - center's director.

Reports were signed and copy of the reports and this report was left with LaShawnda Keys - center's director.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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