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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494399
Report Date: 11/23/2021
Date Signed: 11/23/2021 11:26:10 AM

Document Has Been Signed on 11/23/2021 11:26 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:OAKRIDGE PRESCHOOL AND INFANT CAREFACILITY NUMBER:
197494399
ADMINISTRATOR:MICHELLE PETROVFACILITY TYPE:
850
ADDRESS:10433 TOPANGA CANYON BLVDTELEPHONE:
(818) 454-3415
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 28DATE:
11/23/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:09 AM
MET WITH:Michelle PetrovTIME COMPLETED:
11:45 AM
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On 11/23/2021 Licensing Program Analyst (LPA) conducted an unannounced complaint findings delivery and observed the following deficiency.

An adult not associated to the facility (Blanca Diaz).

Per review of the guardian system Blanca Diaz has a criminal record clearance with Onegeneartion #197402404. Per discussion with Licensing Program Manager Claudia Escobedo, Director provided LPA with documentation to associate the adult individual with the facility by providing the following documents.

LIC 9182 Criminal Background Clearance Transfer,
LIC 508 Criminal Record Statement and a
Copy of social security number
Copy of State of Nevada Drivers License.

Director agrees to not allow Blanca Diaz to care for children in the facility pending criminal record clearance transfer. Director was also provide a list of Criminal Clearance Requirements.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/23/2021
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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