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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017148
Report Date: 06/28/2022
Date Signed: 06/28/2022 11:28:15 AM


Document Has Been Signed on 06/28/2022 11:28 AM - It Cannot Be Edited

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: 48DATE:
06/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Priscilla Lovely, Site SupervisorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) T. Tran conduct an unannounced Case Management inspection at Crystal Stairs- Century Head Start to follow up on a self-reported incident occurred on 05/16/2022 regarding a child in care fell and sustained abrasion on the left eyebrow. The Monterey Park South West Child Care Regional Office received the incident report on 05/16/2022. Upon arrival, LPA met with Site supervisor, Priscilla Lovely and toured of the facility. LPA observed proper care and supervision.

LPA completed files review for staff, children, and obtained child's record. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were two staff supervised 17 children. Parent was contacted in a timely manner. According to 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. 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 Priscilla Lovely.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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