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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018196
Report Date: 02/21/2020
Date Signed: 02/21/2020 11:54:26 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:CHILDREN'S COLLECTIVE INC - MAPLE STREET, THEFACILITY NUMBER:
198018196
ADMINISTRATOR:CHENIEKA MORGAN-MILLSFACILITY TYPE:
850
ADDRESS:255 EAST 28TH STREETTELEPHONE:
(310) 733-4388
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:36CENSUS: 27DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Site Supervisor, Loretta IberosiTIME COMPLETED:
12:10 PM
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Licensing Program Analysts (LPAs) Mayra Rivera and Ariel Cazares conducted a Case Management inspection at the above facility to follow up and conduct additional interviews related to the incident that occurred on 01/06/2020.

LPA's interviewed children and reviewed staff records. At this time additional information is needed prior to determining whether or not a violation occurred.

The content of this report was read and discussed in detail at the time with Site Supervisor Loretta Iberosi..

An exit interview was conducted and a copy of this report and appeal rights were provided.

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



SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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