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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020337
Report Date: 09/21/2021
Date Signed: 09/21/2021 11:53:46 AM

Document Has Been Signed on 09/21/2021 11:53 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: DATE:
09/21/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Steve Heller and Annette Gladstone, LicenseesTIME COMPLETED:
11:45 AM
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An office meeting was conducted today with Licensees Steve Heller and Annette Gladstone. Also present were Regional Manager (RM) Deborah Ajao, Licensing Program Manager Brandi Van Oosten, Licensing Program Analyst (LPA) Judy Mora and LPA Thelma Razo. The purpose of this meeting is to discuss Director qualifications, designation, and director role.

Exit interview conducted with Licensees.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Thelma Razo
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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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