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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016407
Report Date: 05/17/2024
Date Signed: 05/17/2024 02:12:48 PM

Document Has Been Signed on 05/17/2024 02:12 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: 25DATE:
05/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:35 PM
MET WITH:Priscilla Almejo, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On May 17, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Priscilla Ochoa 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. LPAs observed 25 children in care.

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 investigation, LPAs interviewed Staff #1 (S1) to Staff #4 (S4), interviewed Child #1 (C1) to Child #3 (C3) and obtained a copy of the facility roster. LPAs called Parent #1 (P1), there was no answer and LPA left a message with LPAs call back information.

Based on interviews there was no corroborating information to verify that possible personal rights were violated. 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: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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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