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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418419
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:37:23 PM

Document Has Been Signed on 12/13/2022 04:37 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:BALBOA GIFTED MAGNET STARFACILITY NUMBER:
197418419
ADMINISTRATOR:STEPHANIE TREJOFACILITY TYPE:
840
ADDRESS:17020 LABRADOR STREETTELEPHONE:
(310) 386-6359
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY: 90TOTAL ENROLLED CHILDREN: 0CENSUS: 39DATE:
12/13/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
04:33 PM
MET WITH:Gabriel Thompson- DirectorTIME COMPLETED:
04:55 PM
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On 12/12/2022 Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced Annual Required Inspection for the facility. LPA met with Gabriel Thompson, Director and toured the facility indoors and outdoors. LPA observed The “STAR Inc." program operates after school off of the Balboa Gifted Magnet Star site utilizing bungalows 32 and 33. LPA observed all required postings in a prominent area. LPA observed 39 children and 4 adults.

Continuation due to Inspection cool not being completed.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2022
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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