Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418475
Report Date: 02/23/2017
Date Signed 02/23/2017 12:40:14 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:CRYSTAL STAIRS INC.- SULLIVANFACILITY NUMBER:
197418475
ADMINISTRATOR:JONES-LOWE, CONNIEFACILITY TYPE:
850
ADDRESS:725 W. RAYMOND STREETTELEPHONE:
(310) 933-0760
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:120CENSUS: 97DATE:
02/23/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Kimberly Hargrave, Site SupervisorTIME COMPLETED:
12:40 PM
NARRATIVE
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The Licensing Program Analyst (LPA), Tiffanie Tran, conducted a site visit to investigate an incident case management inspection which occurred on 2/2/17. LPA met with site supervisor, Kimberly Hargrave and toured the facility inside and outside. LPA reviewed child’s file and obtained the facility roster. Children, staff members were interviewed.

Based on the facts presented and the information gathered from the interviews it revealed that, child #1 was dramatized by a teacher when she grabbed his throat with her hand during outside time when he was having a conflict with another peer Therefore, the facility is being cited for personal rights violation.

The facility must submit to the department a plan of correction indicating the positive approach when working with children by 3/9/17.

The facility had been cited for Type A deficiency. Appeal Rights was provided.

An exit interview was conducted, a copy of this report was provided to the director.

SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2017
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: CRYSTAL STAIRS INC.- SULLIVAN
FACILITY NUMBER: 197418475
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/23/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2017
Section Cited
101223(a)(3)
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Personal Rights. Each child shall be free from corporal or unusual punishment, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature.
Child #1 was dramatized by a teacher when she grabbed his throat with her hand during outside time when he was having a conflict with another peer.
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Site Supervisor agrees to provide training resources related to positive approaches when working with children for this teacher then submit the agenda, training resources/materials with the signature of attending to the department by 3/9/17.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2017
LIC809 (FAS) - (06/04)
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