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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016571
Report Date: 03/11/2025
Date Signed: 03/11/2025 10:25:37 AM

Document Has Been Signed on 03/11/2025 10:25 AM - 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. DOMINIC SCHOOLFACILITY NUMBER:
198016571
ADMINISTRATOR/
DIRECTOR:		LUCY CUEVASFACILITY TYPE:
850
ADDRESS:2005 MERTON AVENUETELEPHONE:
(323) 255-5803
CITY:LOS ANGELESSTATE: CAZIP CODE:
90041
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 14DATE:
03/11/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Lucy Cuevas, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On March 11, 2025, Licensing Program Analysts (LPAs) Monique Ayala and Monica Ruiz conducted an unannounced Case Management Inspection – Plan of Correction (POC) at the above facility. LPAs met with Director, Lucy Cuevas who guided LPAs on a tour of the facility. LPAs observed 14 children in care with 2 staff. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 03/10/2025 were corrected.

Licensing staff observed and reviewed the following:

· Updated medication for Child #1 (not expired)

Letters of Deficiencies Citations Cleared were provided for deficiencies corrected.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

An exit interview was conducted, and a copy of this report was provided to director, Lucy Cuevas along with Appeal Rights.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: 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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