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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495312
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:38:13 PM

Document Has Been Signed on 09/19/2023 12:38 PM - 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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:PIPER PRESCHOOL AT TRINITY LUTHERANFACILITY NUMBER:
197495312
ADMINISTRATOR:TINA AVILAFACILITY TYPE:
850
ADDRESS:1340 11TH STREETTELEPHONE:
(424) 361-7322
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 0DATE:
09/19/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Rachelle VanderstayTIME COMPLETED:
12:37 PM
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On 9/19/2023 LPA conducted an in office visit with Rachelle Vanderstay of Piper Preschool at Trinity Lutheran, for the purpose of amending a report that was created on 9/6/2023.

A copy of the amended report was discussed and provide to Rachelle Vanderstay - representative.
SUPERVISORS NAME: Deborah Lowe
LICENSING EVALUATOR NAME: Jillinda Chandler
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2023
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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