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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493900
Report Date: 04/13/2023
Date Signed: 04/13/2023 03:43:45 PM

Document Has Been Signed on 04/13/2023 03:43 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: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: 24CENSUS: 16DATE:
04/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Komsoth MaoTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) T. Tran arrived at CII Compton to conduct an unannounced Case Management inspection that was self-reported on 1/13/2023 regarding a child in care fell and sustained a bump on the forehead. The Monterey Park South West Child Care Regional Office received the incident report on 1/17/2023. About 2:00 PM, Designee teacher, Komsoth Mao provided LPA a tour of the facility. LPA observed proper care and supervision.

LPA completed files review for staff, children, and obtained child's record. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were two staff supervised 6 children. According to the available information, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

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, Komsoth Mao.

SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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