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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494846
Report Date: 03/09/2023
Date Signed: 03/09/2023 11:47:07 AM

Document Has Been Signed on 03/09/2023 11:47 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:LEVI FAMILY CHILD CAREFACILITY NUMBER:
197494846
ADMINISTRATOR:LEVI, ADIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 462-3474
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
03/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Adi LeviTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Judy Laureano conducted an unannounced plan of correction visit to observe the correction to the deficiency previously cited.
During the previous visit LPA 11 children presentn and one assistant with licensee and licensee's husband. LPA issued a Type A ciation-Staffing Ratio and Capacity - Type A: 102416.5(a) – please see LIC 809 D.

During today's visit, LPA observed 11 children and 2 staff member. LPA observed the Licensing Evaluation Report posted at the entrance to the facility together with the Notice of Site visit.

The violations previously cited were cleared.

Exit interview was completed with Licensee Adi Levi and a copy of this report was provided with Notice of Site Visit.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/09/2023
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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