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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016407
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:38:02 PM

Document Has Been Signed on 05/09/2024 02:38 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:CII/OTIS BOOTH CDCFACILITY NUMBER:
198016407
ADMINISTRATOR/
DIRECTOR:		PRISCILLA ALMEJOFACILITY TYPE:
850
ADDRESS:424 N. LAKE STREETTELEPHONE:
(213) 260-7717
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Priscilla Almejo, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On May 9, 2024, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection at the above facility. A COIVID-19 risk assessment was conducted prior to entering the facility. LPA met with Site Supervisor, Priscilla Almejo who guided LPA on a tour of the facility. LPA did not observe any children in care as the facility had a shortened day for children.

The purpose of the inspection is to follow up on an incident report that was reported timely to the department on 04/29/2024; the incident occurred on 04/29/2024. The incident is being followed up to ensure there was no personal rights violations.

During the inspection, LPA interviewed Staff #1 (S1) to Staff #4 (S4) and obtained a copy of the facility roster.

There are no deficiencies being cited at this time.

An exit interview was conducted and a copy of this report was provided to Site Supervisor, Priscilla Almejo. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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