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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495287
Report Date: 09/07/2023
Date Signed: 09/07/2023 03:51:19 PM

Document Has Been Signed on 09/07/2023 03:51 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:LA CITY CAREFACILITY NUMBER:
197495287
ADMINISTRATOR:OMAR MCGEEFACILITY TYPE:
830
ADDRESS:6715 WESTERN AVENUETELEPHONE:
(310) 467-4175
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:Omar Mcgee (applicant) / Derrell Pork (director)TIME COMPLETED:
04:12 PM
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On 9/7/2023 Licensing Program Analyst (LPA) Jillinda Chandler made an announced visit to the L.A. City Care for the purpose of conducting a pre-licensing inspection. During the inspection the recorded report made a save-conflict copy. LPA will contact the FAS specialist to retrieve the report. The report was reviewed and signed by LPA and applicant. A copy of the report will be emailed to the applicant.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
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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