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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020953
Report Date: 09/27/2024
Date Signed: 09/27/2024 03:08:34 PM

Document Has Been Signed on 09/27/2024 03:08 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BRELLA HOLLYWOODFACILITY NUMBER:
198020953
ADMINISTRATOR/
DIRECTOR:		REBECCA KELLYFACILITY TYPE:
850
ADDRESS:909 N. ORANGE DR.TELEPHONE:
(213) 300-5962
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 45TOTAL ENROLLED CHILDREN: 50CENSUS: 19DATE:
09/27/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:55 PM
MET WITH:Director Rebecca KellyTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On September 27, 2024, Licensing Program Analysts (LPA) Staicy Perry conducted an unannounced Case Management Inspection – Plan of Correction at the above facility. LPA met with Director Rebecca Kelly, who guided LPA on a tour of the facility. LPA observed 19 children in care. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 09/27/2024 were corrected.

Licensing staff observed, obtained, and reviewed the following:

· Regulation 101212(d)(1)(c) was reviewed and signed and declarations obtained from Director Rebecca Kelly and Assistant regarding their understating of Reporting Requirements.


Letter of Deficiency Citation Cleared was provided for deficiencies corrected. The facility was found to be in compliance with Title 22 Regulations, no deficiencies cited.

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 Rebecca Kelly.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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