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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494766
Report Date: 06/29/2023
Date Signed: 06/29/2023 11:21:10 AM

Document Has Been Signed on 06/29/2023 11:21 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:APPLE SCHOOL EARLY CHILDHOOD EDUCATIONAL CENTERFACILITY NUMBER:
197494766
ADMINISTRATOR:YELENA DOBRYNINAFACILITY TYPE:
850
ADDRESS:14123 VICTORY BLVDTELEPHONE:
(323) 449-1378
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY: 60TOTAL ENROLLED CHILDREN: 56CENSUS: 51DATE:
06/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:YELENA DOBRYNINA, DirectorTIME COMPLETED:
11:20 AM
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On 6/29/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced case management visit. LPA Ornelas met with YELENA DOBRYNINA, Director. LPA toured the facility and observed 51 children in care being supervised by 11 staff.

The Purpose of the visit was to provide Director with a copy of the amended reports

Exit interview was conducted and a copy of this report was provided to Director, Yelena Dobrynina.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2023
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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