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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015865
Report Date: 02/02/2022
Date Signed: 02/02/2022 12:58:20 PM

Document Has Been Signed on 02/02/2022 12:58 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LAD N LASSIE PRESCHOOL & INFANTFACILITY NUMBER:
198015865
ADMINISTRATOR:ANN DAVISFACILITY TYPE:
850
ADDRESS:12620 BROADWAY STREETTELEPHONE:
(562) 945-6466
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY: 207TOTAL ENROLLED CHILDREN: 207CENSUS: 104DATE:
02/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Doris AlvarezTIME COMPLETED:
01:30 PM
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02/02/22 Licensing Program Analyst (LPA) Fabiola Vasquez conducted a case management inspection due
Doris Alvarez Co Owner (CO) disclosing that adults are using the children's restroom.

LPA requested to CO that effective 02/02/22 staff should be using the restroom that is assigned to be used by adults. CO will submit proof to LPA in a memo with staff'' signatures that they were informed that they have to use the adult restroom.

Due by 2/4/22.

Exit interview conducted with Doris Alvarez CO,

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.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2022
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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