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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416987
Report Date: 09/17/2024
Date Signed: 09/17/2024 03:05:07 PM

Document Has Been Signed on 09/17/2024 03:05 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:CHILDREN'S COLLECTIVE, INC. CASA DOMINGUEZ, THEFACILITY NUMBER:
197416987
ADMINISTRATOR/
DIRECTOR:		BACH, ROCIOFACILITY TYPE:
850
ADDRESS:15711 SOUTH ATLANTIC AVE.TELEPHONE:
(310) 637-1593
CITY:E. RANCHO DOMINGUEZSTATE: CAZIP CODE:
90221
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: DATE:
09/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Natasha Crowder-Stallworth, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAs) Portia Bowden and Jeanette Estrada conducted an unannounced case management inspection at the above facility to follow up on an Unusual Incident Report (UIR) received on 8/1/24. Upon arrival at 12:45pm LPAs met with Natasha Crowder-Stallworth Site Supervisor, explained the reason for our visit, and were guided on a tour of the facility. At 12:55PM LPAs observed a total of 23 children present being supervised by 5 staff. Full day Preschool classroom 1 had 12 children while Full day Preschool classroom 2 had 11 children. At time of visit, LPAs observed all children in care to be napping. All adults present were verified to have criminal clearances.

On 8/1/24 a UIR was reported to the Department regarding an alleged incident with Staff 1 and Child 1. Per UIR, parent of child 1 reported to Staff 2 that Child 1 informed them that Staff 1 squeezed child 1’s arm resulting in visible bruising to child 1’s arm. The alleged incident was reporter to have occurred on 7/31/24.

During today's inspection, LPAs interviewed staff and obtained copies of pertinent documents. At this time, further investigation regarding the incident will be conducted by the Department.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Facility Representative.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Portia Bowden
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2024
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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