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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015427
Report Date: 09/19/2019
Date Signed: 09/19/2019 11:09:54 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:MAYWOOD EARLY EDUCATION CAMPUSFACILITY NUMBER:
198015427
ADMINISTRATOR:CLAUDIA GALVANFACILITY TYPE:
850
ADDRESS:3759 E. 57TH STREETTELEPHONE:
(323) 223-3313
CITY:MAYWOODSTATE: CAZIP CODE:
90270
CAPACITY:39CENSUS: 24DATE:
09/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Education CordinatorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at Maywood Early Education Campus on 07/08/19. The Monterey Park SW Regional Office received the incident report on 07/18/19. Upon arrival, LPA met with Education Cordinator. LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

Per staff stated, C1 is no longer enrolled at the facility. Her last day of enrollment 07/05/19. LPA obtained personnel report and children's roster. Due to insufficient evidence, further needed for investigation is required prior concluding this incident investigation.

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: 09/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2019
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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