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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013102
Report Date: 02/06/2020
Date Signed: 02/06/2020 11:38:32 AM

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:NEW LIBERTY CHILD DEVELOPMENT CENTER/DREWFACILITY NUMBER:
198013102
ADMINISTRATOR:DIANN FAUNTLEROYFACILITY TYPE:
850
ADDRESS:5328 CENTRAL AVENUETELEPHONE:
(323) 234-3167
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:82CENSUS: 47DATE:
02/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Yaneth AlfaroTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Mayra Rivera and Ariel Cazares conducted a Case Management inspection at the above facility to follow up on the self reported incident that occurred on 01/15/2020. LPA’s met with Early Intervention Specialist Yaneth Alfaro who guided the LPA’s on a tour of the facility The Monterey
Park South West Child Care Regional Office received the incident report on 01/17/2020.

LPA's interviewed staff, reviewed records, and obtained copies of relevant documents. At this time additional information is needed prior to determining whether or not a violation occurred.

The content of this report was read and discussed in detail at the time with Director Diann Fauntleroy..

An exit interview was conducted and a copy of this report and appeal rights were provided.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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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