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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191802051
Report Date: 08/26/2022
Date Signed: 08/29/2022 03:23:32 PM

Document Has Been Signed on 08/29/2022 03:23 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SALVATION ARMY DAY CARE CTRFACILITY NUMBER:
191802051
ADMINISTRATOR:MARIA RODRIGUEZFACILITY TYPE:
850
ADDRESS:836 STANFORD AVETELEPHONE:
(213) 623-9022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90021
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: DATE:
08/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Rodriguez, DirectorTIME COMPLETED:
09:30 AM
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LPA returned to center to deliver the report and obtain signatures due to the technical difficulties from 08/12/2022 inspection. Signature is obtained on original reports
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Dayna Chambers
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2022
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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