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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009693
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:43:24 PM


Document Has Been Signed on 04/27/2022 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
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:
5622102508
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:38CENSUS: 29DATE:
04/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:TIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection that was self-reported on 11/19/2021. The Monterey Park South West Office received the writing report on 11/19/2021. During the inspection, LPA observed proper care and supervision.

LPA completed child and staff’s files review. LPA obtained child's document, children's roster, and personnel report. Based on the interview conducted, none of the center staff confirm that a S1 hits C1 while in care.At this time based on the available information it does not appear this incident was the result of a Title 22 for Personal Rights violation.

No deficiency was found during today's inspection.

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: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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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