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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020337
Report Date: 07/15/2021
Date Signed: 07/16/2021 06:31:48 AM

Document Has Been Signed on 07/16/2021 06:31 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:SEGRAY EAGLE ROCKFACILITY NUMBER:
198020337
ADMINISTRATOR:STEVE HELLERFACILITY TYPE:
850
ADDRESS:4475 EAGLE ROCK BLVD.TELEPHONE:
(323) 507-2640
CITY:LOS ANGELESSTATE: CAZIP CODE:
90041
CAPACITY: 155TOTAL ENROLLED CHILDREN: 0CENSUS: 52DATE:
07/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Annette Gladstone, LicenseeTIME COMPLETED:
04:30 PM
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On 7/15/2021 at 1:10PM, Licensing Program Analyst (LPA) Thelma Razo arrived at the facility to conduct an unannounced in-person Case Management - Incident inspection. LPA met with Licensee Annette Gladstone. LPA stated the purpose of the visit is due to Unusual Incident which occurred on 7/12/2021 and was self-reported the same day by Ms. Gladstone to Community Care Licensing Division (CCLD). The Unusual Incident was reported within the required time frame. Per report, a parent reported a personal rights violation against a staff member. Per Licensees (Steve Heller and Ms. Gladstone), Staff #1 is on paid leave pending investigation.

LPA toured the facility to include the playground, 5 preschool classrooms and bathrooms. LPA observed 52 children and 12 staff at the facility. Staff-child ratio was met. LPA interviewed Staff #2, Staff #3, Staff #4, Child #1, and Child #2.

No deficiencies were cited in accordance with California Code of Regulations Title 22 at this time.

The Notice of Site Visit (LIC 9213) was given – 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.



Exit interview conducted, appeal rights explained and a copy was given together with the report.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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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