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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493900
Report Date: 12/09/2022
Date Signed: 12/09/2022 10:39:15 AM

Document Has Been Signed on 12/09/2022 10:39 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:CII - COMPTON EARLY HEAD STARTFACILITY NUMBER:
197493900
ADMINISTRATOR:CASTELLNOS, MANNY FLORES,FACILITY TYPE:
850
ADDRESS:537 W COMPTON AVETELEPHONE:
2133855100
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 30TOTAL ENROLLED CHILDREN: 22CENSUS: 12DATE:
12/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Komsoth MaoTIME COMPLETED:
11:00 AM
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On 12/9/2022, about 9:50 AM, Licensing Program Analyst (LPA) T. Tran conducted a case management visit at CII- Compton Early Head Start to deliver the Decision and Order of Exclusion. About 10:00 AM, LPA met with Komsoth Mao, Designee Teacher and we toured the facility.

Based on evidence obtained during today’s visit, LPA has verified the individual was no longer working at this facility. LPA has advised the facility representative to disassociate the individual from their roster. LPA obtained the LIC 500.

LPA had reviewed and provided the Decision and Order to the facility representative.

Exit interview conducted and report was given to the facility representative, Komsoth Mao.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2022
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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