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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418475
Report Date: 11/01/2023
Date Signed: 11/01/2023 03:47:17 PM


Document Has Been Signed on 11/01/2023 03:47 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CRYSTAL STAIRS INC.- SULLIVANFACILITY NUMBER:
197418475
ADMINISTRATOR:JONES-LOWE, CONNIEFACILITY TYPE:
850
ADDRESS:725 W. RAYMOND STREETTELEPHONE:
(310) 933-0760
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:120CENSUS: 83DATE:
11/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Acting supervisor, Veronica RomanTIME COMPLETED:
04:00 PM
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On November 1, 2023 at 1:55 pm, Licensing Program Analysts (LPAs) Angelica Wallin and Jeanette Estrada conducted a Case Management Incident inspection. This inspection is regarding a personal rights incident that took place on August 7, 2023 in which a child received scratches from other students in a class. LPAs met with acting supervisor, Veronica Roman who provided information and assistance during the inspection. A census of 83 children was taken.

During the inspection, LPAs conducted interviews with four staff. LPAs also reviewed the following documents: a August 7, 2023 unusual incident report, ratio sheet on day of incident, and facility education case notes. During conducted interviews, LPAs received no corroborated disclosures of incident. No deficiencies cited at this time.

The content of this report was read and discussed in detail at the time of inspection with acting site supervisor, Veronica Roman. An exit interview was conducted, and a copy of appeal rights was provided.

Notice of Site Visit (LIC 9213) was provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 854-7636
LICENSING EVALUATOR NAME: Angelica WallinTELEPHONE: (626) 366-3613
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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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