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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020337
Report Date: 08/25/2021
Date Signed: 08/25/2021 04:56:08 PM

Document Has Been Signed on 08/25/2021 04:56 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, 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: 86DATE:
08/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Licensee Steve HellerTIME COMPLETED:
05:00 PM
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An unannounced Case Management - Incident visit was held by Licensing Program Analyst (LPA) Thelma Razo and Licensing Program Manager (LPM) Brandi VanOosten. LPA/LPM met with Licensees Steve Heller and Annette Gladstone and stated the purpose of the visit is due to Unusual Incident which occurred on 7/12/2021.

On 7/15/2021, LPA toured the facility to include the playground, 5 preschool classrooms and bathrooms. LPA conducted interviews with staff, children and parent. No disclosures were made.

Based on interviews, and information gathered, center was not cited under California Code of Regulations, Title 22, Division 12 at this time.

The Notice of Site Visit (LIC 9213) was posted and must remain 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: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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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