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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018035
Report Date: 11/04/2022
Date Signed: 11/04/2022 11:59:46 AM


Document Has Been Signed on 11/04/2022 11:59 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:CDCLA-CHINATOWN SERVICE CENTER CHILDREN'S CENTERFACILITY NUMBER:
198018035
ADMINISTRATOR:SILVIA GONZALEZ CAMPOSFACILITY TYPE:
850
ADDRESS:521 W. CESAR E. CHAVEZ AVENUETELEPHONE:
(213) 617-0705
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY:48CENSUS: 13DATE:
11/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Silvia Gonzalez Campos TIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 10/14/2022. LPA met with Director, Silvia Gonzalez Campos, who guided LPA on a tour of the preschool classrooms. LPA conducted interview and obtained documentation during this visit.

The incident that occurred on Friday, 10/14/22 was reported to the Department on Monday 10/17/22; within the required 24 hours of occurrence. On 10/14/22, a child was injured inside a preschool classroom, the injury did not need immediate medical attention and it is unknown if the child was taken to get medical attention as the child has not returned to the facility since the date of occurrence.

LPA visually observed the area where the incident occurred. LPA observed the area to be hazard free. LPA also observed the furniture in the area to be safe and age appropriate. LPA consulted with staff on the types of hooks to use in the classroom in order to prevent any similar injury.

Based on all information obtained and interview conducted with staff who were present when the injury occurred, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. The facility staff could not have done anything to prevent the incident from occurring and preventative measures will be taken in order to prevent a similar injury.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

There were no deficiencies observed in regards to today's inspection. Exit interview was conducted with Director, Silvia Campos. Appeal rights explained & provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/04/2022
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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