197492957-12-17-2025-30-CC-VWHY-DPFQ4S-20251217105047

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197492957
Report Date: 12/12/2025
Date Signed: 12/17/2025 10:50:55 AM

Document Has Been Signed on 12/17/2025 10:50 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	WEST LA EXTENDED DAY		FACILITY NUMBER:	197492957
ADMINISTRATOR/ DIRECTOR:	JOLENE DOUCETTE		FACILITY TYPE:	840
ADDRESS:	6550 W. 80TH STREET		TELEPHONE:	(310) 642-8386
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90045
CAPACITY: 180	TOTAL ENROLLED CHILDREN: 180	CENSUS: 57	DATE:	12/12/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	03:00 PM
MET WITH:	Kimberly Raza		TIME VISIT/ INSPECTION COMPLETED:	04:45 PM

NARRATIVE

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On 12/12/2025, Licensing Program Analyst (LPA) Veronica Wheatley conducted an unannounced Case Management Inspection due to an Unusual Incident/ Injury Report that was called in on 12/9/2025 and reported to the Regional Office. LPA met with Senior Director, Kimberly Raza and informed her about the reason of the visit. LPA toured the premises inside and outside and observed the children supervised properly and within proper ratios.

According to the Unusual Incident/ Injury Report, Child #1 was injured on the playground and sustained a head injury. LPA inspected the outdoor area whereby the child was injured. LPA observed age appropriate soft and hard large Legos on the yard. LPA did not observe any hazards on the yard.

LPA interviewed the senior director, Staff #1 and Staff #2. LPA reviewed the child's file and after visit medical summary. LPA spoke to Child #1's parent who stated the doctor released the child with no restrictions. The child returned to the program on 12/11/25. LPA observed Child #1 on the premises today playing inside. The director followed the required protocol by calling the incident into the Department and submitted LIC 624 (Injury Report) timely.

Based on LPA's interviews which were conducted, information obtained through interviews, and, per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

An exit interview was conducted, a copy of this report was read and provided to the director. This report shall me made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Maureen Neal
NAME OF LICENSING PROGRAM ANALYST: Veronica Wheatley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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