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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416919
Report Date: 10/10/2024
Date Signed: 10/10/2024 02:51:35 PM

Document Has Been Signed on 10/10/2024 02:51 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SPIRIT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197416919
ADMINISTRATOR/
DIRECTOR:		KEENA TAYLORFACILITY TYPE:
850
ADDRESS:4061 WEST WASHINGTON BOULEVARDTELEPHONE:
(323) 737-2467
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 31DATE:
10/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Keena TaylorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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On 10/10/24 at 2:30 pm Licensing Program Analyst Claudia Kam conducted a Case Management incident inspection at the above facility to follow up on injury. Upon arrival, LPA met with Assistant Director Keena Taylor, who provided a tour of the facility. LPA observed proper care and supervision. The Monterey Park South West Child Care Regional Office did not receive an unusual incident report for injury.

LPA completed record review and interviews were conducted. Based on the information that was available
Medical attention was provided and incident report was created and provided to guardian.


LPA discussed reporting requirements and provided Title 22 regulation 101212 (d)(1)(c) in addition to Unusual incident report form as well as office number and email for mspwincidentreport@dpss.ca.gov

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 Assistant Director, Keena Taylor.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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