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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015427
Report Date: 01/15/2020
Date Signed: 01/15/2020 09:22:33 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: 31DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Site SupervisorTIME COMPLETED:
09:35 AM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to deliver the final finding of a Case Management Incident that was self-reported. The incident 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 Site Supervisor. LPA observed proper care and supervision.

Based on the available information and interviews and record reviews were conducted. Parents of C1 would like to retract the concern in regard a teacher tickled child's "pee pee." Center staff did not observe any teacher tickled children at the center. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

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: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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