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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600175
Report Date: 05/15/2024
Date Signed: 05/16/2024 08:31:17 AM

Document Has Been Signed on 05/16/2024 08:31 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COVENANT PRESBYTERIAN CHURCH PRESCHOOLFACILITY NUMBER:
191600175
ADMINISTRATOR/
DIRECTOR:		SULTAN, KATHLEENFACILITY TYPE:
850
ADDRESS:6323 WEST 80 STREETTELEPHONE:
(310) 670-5758
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 74TOTAL ENROLLED CHILDREN: 74CENSUS: DATE:
05/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Kathy SultanTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On 5/15/24 Licensing Program Analysts (LPA) Ranita Richmond and Devon Carus arrived at the above named facility to conduct an unannounced Case Management visit to capture signatures due to system error during annual required visit on 4/17/24.

LPA met with Kathy Sultan, site supervisor.

No citations issued.
Exit interview conducted and notice of site visit provided.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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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