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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018055
Report Date: 03/27/2023
Date Signed: 03/27/2023 11:28:12 AM


Document Has Been Signed on 03/27/2023 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CHILDRENS INSTITUTE/IMPERIAL COURTSFACILITY NUMBER:
198018055
ADMINISTRATOR:AKIDA CROSBYFACILITY TYPE:
850
ADDRESS:11425 GORMAN AVE.TELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90059
CAPACITY:24CENSUS: 0DATE:
03/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Carmelita ShortsTIME COMPLETED:
11:40 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) T. Tran arrived at CII-Imperial Courts Head Start to conduct a Case Management Incident inspection that was self-reported on 03/13/2023 regards a lack of care and supervision concerns. Upon arrival at 8:45 AM, LPA met with Site Supervisor, Carmelita Shorts. LPA did not observe any children in care. Per Site Supervisor, children have non-class day on 3/27/23 and 3/28/23 due to staff development day.

Staff and child file review was completed. LPA obtained staff and child's records. Interview was conducted with staff. On the day of the incident, there were 9 children outside with two staff. Due to insufficient information available at this time, the above allegation need further investigation.

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, Carmelita Shorts.

SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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