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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494575
Report Date: 06/28/2024
Date Signed: 06/28/2024 09:02:55 AM

Document Has Been Signed on 06/28/2024 09:02 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DEVONSHIRE INFANT CENTERFACILITY NUMBER:
197494575
ADMINISTRATOR/
DIRECTOR:		MERCEDES DIAZFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 46TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
06/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Mercedes Diaz, DirectorTIME VISIT/
INSPECTION COMPLETED:
09:15 AM
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On 06/28/2024 at 8:00 AM, Licensing Program Analyst (LPA) Elicia Calvillo conducted an unannounced Case Management -Other visit. Facility is located at 21203 Devonshire Avenue, Granada Hills, CA 91311. LPA identified self and met with Mercedes Diaz, Director. There were 2 children and 1 staff upon arrival.

Facility Representative (FR) Mercedes Diaz, Director allowed entry to facility and provided LPA a guided tour of inside and outside of the facility.

LPA identified reason for visit was to obtain signatures on an amended complaint report.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are being cited during today’s visit.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted with Mercedes Diaz, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Elicia Calvillo
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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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