197418475-9-15-2021-54-CC-ABAY-C6VRPW-20210915131238

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197418475
Report Date: 09/15/2021
Date Signed: 09/15/2021 01:13:07 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:	CRYSTAL STAIRS INC.- SULLIVAN		FACILITY NUMBER:	197418475
ADMINISTRATOR:	JONES-LOWE, CONNIE		FACILITY TYPE:	850
ADDRESS:	725 W. RAYMOND STREET		TELEPHONE:	(310) 933-0760
CITY:	COMPTON	STATE: CA	ZIP CODE:	90220
CAPACITY:	120	CENSUS: 51	DATE:	09/15/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Kimberly Hargrave- Education Coordinator		TIME COMPLETED:	11:40 AM

NARRATIVE

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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Alicia Bailey to address an Unusual Incident Report that was received in the licensing office on 05/28/2019. LPA met with Education Coordinator Kimberly Hargrave at 10:26 am.

LPA Bailey and Education Coordinator toured the facility, at the time of the inspection all ratios were compliant according to Title 22 Regulations.

On 05/28/2019 Child # 1 was climbing on the playground structure lost his step and hit his forehead. Staff # 1 witness incident and immediately applied Ice pack and contact the parent. Child # 1 return to school. Child # 1 no longer attends the school due to age requirement .

Based on today’s inspection, and interviews conducted, the facility followed the appropriate Reporting Requirements, Notified Parent, no follow-up is necessary regarding the incident. Education Coordinator followed the required protocol for reporting requirements" as the incident was reported to Child Care Licensing. It does not appear this incident was the result of a Title 22 violation and the facility followed the appropriate regulations to care for the children in care. No deficiencies were cited on this date.

Upon receipt, Notice of Site Visit shall be posted for thirty (30) days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview was conducted, and a copy of this report was provided to Education Coordinator Kimberly Hargrave. Notice of Site visit was issued

SUPERVISOR'S NAME: Karen Chambers	TELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Alicia Bailey	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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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