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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806104
Report Date: 09/22/2023
Date Signed: 09/22/2023 01:16:53 PM

Document Has Been Signed on 09/22/2023 01:16 PM - 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:DOLORES MISSION WOMEN'S COOPERATIVE CHILD CARE CTRFACILITY NUMBER:
191806104
ADMINISTRATOR:VERONICA HERRERAFACILITY TYPE:
850
ADDRESS:157 S. GLESS ST.TELEPHONE:
(323) 881-0010
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 14DATE:
09/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Elizabthe Murillo, TeacherTIME COMPLETED:
01:35 PM
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On September 22, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the above facility. The purpose of the inspection is to follow up on an incident that occurred on 02/02/2023 and was reported to the department timely (02/03/2023). A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with teacher Elizabeth Murillo who guided LPA on a tour of the facility. LPA observed 14 children in care with 3 staff.

Brief Summary: On 02/02/2023, Upon pick up Child #1 (C1) disclosed to parent #1 (P1) that teacher hits C1 in the private area.

During the inspection LPA interviewed Staff #1 and Staff #2, LPA requested for C1's contact information be forwarded to LPA via email as C1 no long attends the facility.

There are no deficiencies being issued at this time as the incident requires further investigation.

An exit interview was conducted and a copy of this report along with Notice of Site Visit was provided to teacher, Elizabeth Murillo. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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