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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416586
Report Date: 10/28/2021
Date Signed: 10/28/2021 03:17:16 PM

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:STANFORD PRIMARY CENTER CSPPFACILITY NUMBER:
197416586
ADMINISTRATOR:GOGUE, ROMERO C.FACILITY TYPE:
850
ADDRESS:3020 KANSAS AVENUE RM #2TELEPHONE:
(323) 563-9208
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:24CENSUS: 8DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Norma Monroy, Facility RepresentativeTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced case management inspection at the above facility on 10/28/21 at 2:30PM for the purpose of addressing an incident that occurred on 10/22/21. LPA met with Norma Monroy, Facility Representative (FR) who guided analysts on a tour of the facility.

Facility was observed to by in ratio and children were under direct supervision of staff.

On 10/22/21 LPA arrived at the facility to conduct an annual inspection. LPA rang the bell to enter the facility. LPA was asked for a daily pass (a QR code to confirm negative COVID-19 test) to enter the facility. Office staff notified LPA that they would not be allowed to enter the facility without a daily pass. LPA did not have a daily pass so facility staff did not allow entrance. Per Health and Safety Code, licensing staff has inspection authority. Per Principal Salazar, she is aware of this regulation but she was in meeting, the regular office staff was out and there were parent representatives helping in the office.

LPA reminded facility representative that any duly authorized officer, employee, or agent of the department may, upon presentation of proper identification, enter and inspect any place providing personal care, supervision, and services at any time, with or without advance notice, to secure compliance with, or to prevent a violation of, this act or the regulations adopted by the department pursuant to the act.

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

Exit interview conducted and report was reviewed with the Facility Representative, Norma Monroy.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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