<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009693
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:11:47 PM

Document Has Been Signed on 11/01/2024 01:11 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:JOHNSTON ELEMENTARY SCHOOLFACILITY NUMBER:
198009693
ADMINISTRATOR/
DIRECTOR:
SOFIA ESPINOZAFACILITY TYPE:
850
ADDRESS:13421 S. FAIRFORD AVE.TELEPHONE:
(562) 210-2508
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 38TOTAL ENROLLED CHILDREN: 26CENSUS: 18DATE:
11/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Laura PerezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) T. Tran and K. Dunlap conducted an unannounced Case Management Incident visit at the above licensed facility to follow up on a self-reported incident occurred on 10/08/2024. The Monterey Park Southwest Office received the writing report on 10/09/2024. LPAs met with Laura Perez and we toured of the facility. LPAs observed proper care and supervision.

LPAs completed child’s files review. Staff files located at the main office not available at the site for review. LPA obtained child’s records and personnel report. Interviews were conducted with staff, children, and other. On the day of the incident, there were 10 children with two teachers. S1 observed C1 ran up the play structure and fell hit the chin on the steps. Child sustained a cut on the chin and required two stitches. Parent was notified of the incident. Based on the interviews conducted and the information that was gathered, 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, Laura Perez.

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1