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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493688
Report Date: 03/17/2023
Date Signed: 03/17/2023 10:33:56 AM

Document Has Been Signed on 03/17/2023 10:33 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:ACADEMY AT MANHATTAN BEACH, THEFACILITY NUMBER:
197493688
ADMINISTRATOR:WESSEL, VIDAFACILITY TYPE:
850
ADDRESS:1114 22ND STREETTELEPHONE:
(310) 546-1700
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 125TOTAL ENROLLED CHILDREN: 74CENSUS: 57DATE:
03/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Sylvia Ruiz, DirectorTIME COMPLETED:
10:50 AM
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On 03/17/2023 Licensing Program Analyst Shandra Powell made an unannounced Case Management visit for the purpose of obtaining signature from director on an amended report. The original complaint report was completed on 03/14/2023. LPA met with Sylvia Ruiz, Director. All pages of the amended report have been signed and delivered.

A copy of the reports and this report was left with Sylvia Ruiz, Director.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2023
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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