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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870707
Report Date: 04/19/2022
Date Signed: 04/19/2022 04:35:10 PM


Document Has Been Signed on 04/19/2022 04:35 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:COLLINS EARLY EDUCATION CENTERFACILITY NUMBER:
191870707
ADMINISTRATOR:ELIZABETH BLACKWELLFACILITY TYPE:
850
ADDRESS:901 WEST 52ND STREETTELEPHONE:
(323) 752-2119
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:114CENSUS: 12DATE:
04/19/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Cedrick Eddy, Faciltiy RepresentativeTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection on 4/19/22 at 4:00 PM. Upon arrival, LPA met with Cedrick Eddy, Facility Representative (FR) who guided analyst on a tour of the facility. There were 12 children present during inspection.

On 4/6/2022, FR submitted an unusual incident report to the Department. LPA obtained accident report signed by parent, written statement from teacher who witnessed incident and doctor's note to return to school.

Due to insufficient information available at this time, LPA will return for subsequent visit.

No deficiencies were cited today 4/19/22. Facility Representative met reporting requirements for this incident.

A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted with Facility Representative, Cedrick Eddy.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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