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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009693
Report Date: 01/11/2024
Date Signed: 01/11/2024 03:23:26 PM


Document Has Been Signed on 01/11/2024 03:23 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:JOHNSTON ELEMENTARY SCHOOLFACILITY NUMBER:
198009693
ADMINISTRATOR:SOFIA ESPINOZAFACILITY TYPE:
850
ADDRESS:13421 S. FAIRFORD AVE.TELEPHONE:
5622102508
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:38CENSUS: 31DATE:
01/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Loretta GallegosTIME COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) T. Tran conducted an unannounced Case Management Incident visit at the above licensed facility to follow up on a self-reported incident occurred on 11/15/2023 involved two children in care. The Monterey Park Southwest Office received the writing report on 11/16/2023. LPA met with Loretta Gallegos, Assistant Director and we toured of the facility. LPA observed proper care and supervision.

LPA completed children’s files review. Staff files located at the main office not available at the site for review. LPA obtained children’s records, and personnel report. Interviews were conducted with staff, children, and other. On the day of the incident, there were 15 children with two teachers. Parent was notified of the incident. Based on the interviews conducted and the information that was gathered, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

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 the facility representative, Loretta Gallegos.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/11/2024
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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