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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494325
Report Date: 01/21/2022
Date Signed: 01/21/2022 12:27:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CRYSTAL STAIRS HEAD START - CHAPEL OF PEACEFACILITY NUMBER:
197494325
ADMINISTRATOR:CARDENAS, LAURAFACILITY TYPE:
850
ADDRESS:1009 NORTH MARKET STREETTELEPHONE:
(323) 421-1100
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY:55CENSUS: 17DATE:
01/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Donia LelandTIME COMPLETED:
12:30 PM
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On 1/21/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Case Management – Incident inspection for the purpose of following up on an Unusual Incident Report (UIR) submitted on 12/14/2021. LPA met with Donia Leland, Site Supervisor, who toured LPA through the inside and outside of the facility. LPA observed 17 children in care with 3 staff.

According to the UIR, on 12/13/2021, Parent 1 (P1) notified the facility that Staff 1 hit Child 1 (C1) on the head and mouth. C1’s sibling, Adult 1 (A1), served as a language interpreter for P1. C1 has not returned to the facility since 12/10/2021. Staff did not observe the incident nor any visible injuries on C1.



During the investigation, LPA interviewed Site Supervisor, Staff 1, Staff 2, Staff 3, P1, A1, C1, and Child 2. LPA obtained the children’s roster (LIC9040), personnel file for the substitute teacher, and Crystal Stairs monthly attendance sheets for November and December 2021.

No enough information was revealed; therefore, no deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Site Supervisor, Donia Leland.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Lillian J CasillasTELEPHONE: (424) 301-3097
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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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