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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198207916
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:05:34 PM

Document Has Been Signed on 02/14/2023 12:05 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, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245
FACILITY NAME:FIRST PLACE FOR YOUTHFACILITY NUMBER:
198207916
ADMINISTRATOR:KUGELBERG, JAMIEFACILITY TYPE:
726
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 250CENSUS: 136DATE:
02/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Lamont Walker-Regional Director of Programs TIME COMPLETED:
10:25 AM
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On February 14, 2023 at 8:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to First Place for Youth THP+FC for the purpose of conducting a Case Management for Special Incident Report #841202. LPA met with Lamont Walker, Regional Director of Programs and discussed the incident.

During this visit, confidential interviews were conducted. Additional interviews will be conducted at a later date. LPA discussed CCL Reporting Requirements with licensee. LPA requested and was provided a copy of the current LIC 500 and the participant list. This case management needs further investigation.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

Exit interview was conducted, and a copy of this report will be emailed to the Regional Director of Programs.

SUPERVISORS NAME: Lakescia Smith
LICENSING EVALUATOR NAME: Daphne Edison
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2023
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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