Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418475
Report Date: 12/19/2017
Date Signed 12/19/2017 03:19:39 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: 95DATE:
12/19/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Maria Navarro, Site SupervisorTIME COMPLETED:
03:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Tiffanie Tran conducted a Case Management Incident inspection to follow up on a self-reported incident that occurred at Crystal Stairs Sullivan Head Start on 11/29/17. The facility made the 24 hours self-report on 12/04/17. The Culver City Child Care Regional Office received the incident report on 12/6/17.

Reporter stated, during outside time, a child informed her teacher that child #1 pulled down her pants. Child # 1 responded she been watching adult stuff at home. Staff took this opportunity and discussed with her class about keeping our body safe. Staff also reported to DCFS on a timely manner. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1