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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801240
Report Date: 03/09/2022
Date Signed: 03/10/2022 08:47:54 AM

Document Has Been Signed on 03/10/2022 08:47 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:LEARNING CENTER, THEFACILITY NUMBER:
405801240
ADMINISTRATOR:JEFFERS, RANEILEFACILITY TYPE:
775
ADDRESS:1610 W GRAND AVETELEPHONE:
(805) 473-3005
CITY:GROVER BEACHSTATE: CAZIP CODE:
93433
CAPACITY: 50CENSUS: DATE:
03/09/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) De Leon attempted infection control annual to the above facility. Facility looked vacant a few table and chairs were present through the window.

LPA called and left message on facility phone to call LPA.

LPA called and left message on Administrator phone.

Administrator called LPA a 3:55 PM and stated the day program is only running online services and has not opened to in person services at this time.

Administrator can met LPA at the facility location for an annual on another date and time.

LPA will arrange a future visit to complete the annual.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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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