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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416987
Report Date: 11/19/2024
Date Signed: 11/19/2024 10:33:52 AM

Document Has Been Signed on 11/19/2024 10:33 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S COLLECTIVE, INC. CASA DOMINGUEZ, THEFACILITY NUMBER:
197416987
ADMINISTRATOR/
DIRECTOR:		BACH, ROCIOFACILITY TYPE:
850
ADDRESS:15711 SOUTH ATLANTIC AVE.TELEPHONE:
(310) 637-1593
CITY:E. RANCHO DOMINGUEZSTATE: CAZIP CODE:
90221
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 29DATE:
11/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Natasha Crowder Stallworth, Site Supervisor TIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 11/19/24 Licensing Program Analysts (LPAs) Portia Bowden and Tiffani Tran conducted a case management visit at the above facility to follow up on a fingerprint clearance for a center staff. At 10:10AM LPAs met with Site Supervisor Natasha Crowder Stallworth and were guided on a tour of the facility. During this inspection it was determined all employees associated had current criminal background clearances.

Based on Evidence obtained during today's visit, LPAs verified the individual is not present at the facility and the individual has been disassociated from the facility. LPAs obtained an updated LIC 500.

The facility was found in compliance with Title 22 regulations, no deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

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

Exit interview conducted and report provided to Site Supervisor Natasha Crowder Stallworth.
Karen ChambersTELEPHONE: (323) 981-3350
Portia BowdenTELEPHONE: (323) 981-3350
DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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