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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009693
Report Date: 03/09/2022
Date Signed: 03/09/2022 03:25:03 PM


Document Has Been Signed on 03/09/2022 03:25 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
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: 24DATE:
03/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Cynthia Allen, Assistant DirectorTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) T. Tran arrived at the above licensed facility to conduct an unannounced Case Management Incidents visit. The Monterey Park South West Child Care Regional Office received multiple incident reports pertaining to children with challenging behaviors. Upon arrival, LPA observed proper care and supervision.

Incident occurred on 9/27/21, 9/24/21, 2/7/22, 2/8/22, 2/22/22, 2/24/22, & 3/3/22. LPA completed staff and children files reviewed. LPA obtained personnel report and children record. Based on the information that were gathered through interviews with staff and other, the facility had been providing ongoing to support to staff and children regarding care and supervision. The facility had Mental Health Consultant and Education Coach also visited the site monthly or as needed to provide different techniques and strategies to help foster children development. In addition, the facility also offered Mental Health Services to the families. LPA obtained support documents for the record. According to the available information, it does not appear this incident was the result of the 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, Cynthia Allen.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
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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