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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015068
Report Date: 08/23/2024
Date Signed: 08/23/2024 02:58:04 PM


Document Has Been Signed on 08/23/2024 02:58 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:CENTRO DE MILAGROS L.A.C.C. & DEVELOP COUNCILFACILITY NUMBER:
198015068
ADMINISTRATOR:ALMA GUZMANFACILITY TYPE:
850
ADDRESS:1328 JAMES M. WOOD BLVD.TELEPHONE:
(213) 382-4081
CITY:LOS ANGELESSTATE: CAZIP CODE:
90015
CAPACITY:47CENSUS: 35DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Alma GuzmanTIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPA) Claudia Kam conducted a case management visit at the above facility for the purpose of follow up on a reported unusual incident. Upon arrival, LPA met with Alma Guzman, director and provided LPA a tour of the facility. LPA observed proper care and supervision.


Interviews were conducted with staff present who witnessed the incident. On the day of the incident, there were 9 children with 3 staff present. Parent was notified of the incident. Child returned to care 8/14/2024 and was observed at the time of the visit to no longer have stiches and interacting with the staff and children without limitations. Chair was observed to be an age appropriate outdoor chair from Lakeshore and well maintained with no sharp corners or pieces. Based on the available information 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 on 8/23/2024.

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, Alma Guzman.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Claudia KamTELEPHONE: (626) 602-6842
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024
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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