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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018402
Report Date: 02/26/2020
Date Signed: 02/26/2020 12:11:30 PM

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:PUREST ACADEMY FOR KIDS INC.- PRESCHOOLFACILITY NUMBER:
198018402
ADMINISTRATOR:AUSTIN, NICOLEFACILITY TYPE:
850
ADDRESS:12235 CENTRALIA ST.TELEPHONE:
(562) 275-5800
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY:29CENSUS: 22DATE:
02/26/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Nicole AustinTIME COMPLETED:
12:30 PM
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A Case Management inspection was conducted by Licensing Program Analysts (LPAs), Jonah Myson and Raul Navarro. LPAs met with Director Nicole Austin who guided LPAs on a tour of the facility. There was a total of 22 children present with four staff.

This inspection was conducted to conduct interviews related to the incident that was reported 02/03/2020, where a child sustained an injury that required medical attention.

During this inspection interviews were conducted with day-care staff and children.

Due to insufficient information available at this time, the above incident needs further investigation.

Exit interview conducted with Director Nicole Austin during which appeal rights were explained. A copy of the appeal rights (LIC9058 01/16) were provided. The Directors signature on this report acknowledges receipt of their rights.

The notice of site visit was posted where the parent/guardian of children enter and exit the facility. This notice shall remain posted for 30 consecutive days.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Jonah MysonTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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