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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017148
Report Date: 09/30/2019
Date Signed: 09/30/2019 11:01:36 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:CRYSTAL STAIRS, INC - CENTURYFACILITY NUMBER:
198017148
ADMINISTRATOR:KIMBERLY HARGROVEFACILITY TYPE:
850
ADDRESS:1700 IMPERIAL HIGHWAYTELEPHONE:
(323) 214-0020
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:80CENSUS: 51DATE:
09/30/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Site SupervisorTIME COMPLETED:
11:15 AM
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 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 Crystal Stairs, INC. Century on 06/27/19. The Monterey Park SW Regional Office received the incident report on 06/27/19. Upon arrival, LPA met with Site Supervisor and about 8:50 AM we toured the facility. 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.

Based on the information that were gathered through interview, it revealed that, on the day of the incident there were 15 children with three teachers. Per staff stated, on that day children were more energetic than usual due to the end of school year celebration. About 3:30 PM, at the carpet while teachers were getting children ready for their performance C1 fell and hit his forehead on the edge of the shelf. C1 sustained a cut on his forehead, medical attention required. Parent was contacted. There were no other children involved, at this time 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.

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: 09/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2019
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