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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009693
Report Date: 12/03/2019
Date Signed: 12/03/2019 04:23:42 PM

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:JOHNSTON ELEMENTARY SCHOOLFACILITY NUMBER:
198009693
ADMINISTRATOR:SOFIA ESPINOZAFACILITY TYPE:
850
ADDRESS:13421 S. FAIRFORD AVE.TELEPHONE:
(562) 210-2508
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:38CENSUS: 32DATE:
12/03/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Assistant DirectorTIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility for the purpose of following up on an Unusual Incident that occurred at Johnson Elementary School on 11/21/19. The facility had self-reported the incident on 11/21/19 and the department had received the written report on 11/22/19.

LPA reviewed children, staff records and obtained child's document and facility personnel report. Based on the information that were gathered through interview and observation, it revealed that, during large group, due to sharing conflict both children were encountered C1 became explosive and kicked C2 on the stomach. Child observed to be fine, no visual marks or bruises. Staff have development new strategies to work with both children in regards to sharing. Both parents were informed accordantly. There were two teachers and 17 children were present. Based on the available information, staff handled this situation well. There was no result of a Title 22 violation for lack of care and supervision. No deficiency was cited.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.


SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2019
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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