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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494322
Report Date: 02/16/2023
Date Signed: 02/16/2023 12:45:29 PM

Document Has Been Signed on 02/16/2023 12:45 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CRYSTAL STAIRS HEAD START - JEFFERSON FELTONFACILITY NUMBER:
197494322
ADMINISTRATOR:CARDENAS, LAURAFACILITY TYPE:
850
ADDRESS:10521 HAWTHORNE BLVDTELEPHONE:
(323) 421-2662
CITY:INGLEWOODSTATE: CAZIP CODE:
90304
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 49DATE:
02/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Netsanet LessaneworkTIME COMPLETED:
12:44 PM
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 On 02/16/2023 Licensing Program Analyst ( LPA) Doris Whitmore conducted an unannounced Case Management for the purpose of following up on an Unusual Incident Report( UIR) that occurred on 01/24/2023 Upon arrival, LPA met with Site Lead Designee Netsanet Lessanework and informed the nature of the visit. There was a total of 49 children and 12 staff. The El Segundo Regional Office received an Unususal Incident/injury report on 01/31/2023. The report stated that the therapist of child#1 informed SS that the child had a mark on the back of his neck. SS went into the classroom and saw Child#1 the back of the neck was red and appeared to have finger mark. S2( S2) stated that child#1 was fighting with another child when she separated him and accidentally scratched child#1 on the neck. Parent#1 stated the child told her Staff #2 scratched him.

During the investigation LPA interviewed the Site Supervisor, Staff #2 Child#1, Child#2& Parent on the phone.
LPA obtained a copy of the Facility Roster, Personnel Report, Education Notes on Child#1,& Accident/ Incident Report& LIC500.

LPA Whitmore obtained that additional information is needed. Exit interview was conducted with Site Lead Netsanet Lessanework copy of report and Notice of Site Visist issued.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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