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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418480
Report Date: 10/06/2023
Date Signed: 10/09/2023 08:34:37 AM


Document Has Been Signed on 10/09/2023 08:34 AM - 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:CRYSTAL STAIRS-DOLLARHIDEFACILITY NUMBER:
197418480
ADMINISTRATOR:KEYS, TERESAFACILITY TYPE:
850
ADDRESS:1108 N. OLEANDER AVE.TELEPHONE:
(310) 933-0700
CITY:COMPTONSTATE: CAZIP CODE:
90222
CAPACITY:80CENSUS: 50DATE:
10/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maricela Villavicencio, Site Supervisor TIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Alicia Mooberry and Anthony Padilla arrived at the above facility to conduct a Case Management inspection for incident that was reported by the facility on 9/13/23 regards a personal rights concern for a child in care.

Licensing staff conducted file reviews and interviewed children and staff and obtained personnel list and children's roster. Due to insufficient information available at this time, the above incident needs further follow-up.

No deficiency was cited at this time. 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, Maricela Villavicencio.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2023
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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