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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408585
Report Date: 03/20/2024
Date Signed: 03/20/2024 09:55:08 AM


Document Has Been Signed on 03/20/2024 09:55 AM - 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612



FACILITY NAME:KATO, AKIKOFACILITY NUMBER:
073408585
ADMINISTRATOR:KATO, AKIKOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(323) 359-8951
CITY:EL CERRITOSTATE: CAZIP CODE:
94530
CAPACITY:14CENSUS: 11DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:KATO, AKIKOTIME COMPLETED:
10:30 AM
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On March 20, 2024 at 9:00AM Licensing Program Analyst (LPA) Nyeesha Blount conducted an unannounced Case Management visit in regards to an Unusual Incident that was reported on March 3, 2024.
LPA met with Licensee Kato, Akiko present during the inspection were (2) staff members (1) infant, (10) preschool children. A incident occurred in the outdoor play area on the jungle gym where a child was climbing and fell done injuring himself.


No deficiencies were cited during today's visit. Exit interview conducted.
A copy of the report and appeal rights provided to Licensee Kato, Akkio
Notice of Site Visit provided.
SUPERVISOR'S NAME: Mayla MendozaTELEPHONE: (510) 292-9724
LICENSING EVALUATOR NAME: Nyeesha BlountTELEPHONE: (510) 566-2319
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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