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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
197495477
Report Date:
10/02/2024
Date Signed:
10/02/2024 08:57:02 AM
Document Has Been Signed on
10/02/2024 08:57 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 RO
,
300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO
,
CA
90245
FACILITY NAME:
PIPER PRESCHOOL
FACILITY NUMBER:
197495477
ADMINISTRATOR/
DIRECTOR:
CRYSTAL BILTZ
FACILITY TYPE:
860
ADDRESS:
807 ARIZONA AVENUE
TELEPHONE:
(310) 451-4600
CITY:
SANTA MONICA
STATE:
CA
ZIP CODE:
90401
CAPACITY:
191
TOTAL ENROLLED CHILDREN:
191
CENSUS:
DATE:
10/02/2024
TYPE OF VISIT:
Office
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:
Jennifer Sphall
TIME VISIT/
INSPECTION COMPLETED:
09:01 AM
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On 10/2/2024 Licensing Program Analyst (LPA) met with Jennifer Sphall for the purpose of conducting a office visit to sign a licensing report dated 10/1/2024
SUPERVISORS NAME
:
Deborah Lowe
LICENSING EVALUATOR NAME
:
Jillinda Chandler
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/02/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/02/2024
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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