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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191201896
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:40:19 PM


Document Has Been Signed on 09/29/2023 02:40 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:LA CRESCENTA PRESBYTERIAN CHURCH CTR. FOR CHILDREFACILITY NUMBER:
191201896
ADMINISTRATOR:CHAMBERS, PATRICIAFACILITY TYPE:
850
ADDRESS:2902 MONTROSE AVETELEPHONE:
(818) 249-8124
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY:111CENSUS: 28DATE:
09/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Patricia Chambers, Director and Julie Larson, Assistant DirectorTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management- incident inspection on 09/29/23 at 11:30 AM due to an incident that occurred on Thursday 09/07/23. LPA met with Julie Larson, Assistant Director. Shortly after, Patricia Chambers, Director arrived who guided analyst on a tour of the facility.

Alleged Incident took place on 09/07/23. Incident was reported via fax next working day. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by fax on Friday 09/08/23. The facility reported the incident within the required 24 hour time frame.

LPA conducted interviews with director and two staff. LPA reviewed child#1's file and obtained copies of child#1 Physician's Report (LIC 701), Child#1's Health History (LIC 702). LPA also obtained copies of incident report that was given to child#1 and child#2 parents. During this inspection director submitted a Biting Policy information that will be posted at the facility website by Monday 10/02/23, and copies will be given to parents.

Based on staff interviews, child#1 bit child#2 on 09/07/23 at 5:05 PM after child#2 sat on child#1 in the book area of class. There were 5 children in the classroom at that time with two staff. Per staff interviews, staff#2 observed the incident. Per staff interviews, no history on child#1's file. Per staff, child#1 bit child#2 because child#2 came into child#1's personal space.

Per director, an ouch report was given to both parents. A meeting was held with teachers. Child#1 was moved from classroom. Teachers were given an article about Biting Child and how do stop biting. Also teachers watched a video on youtube regarding bitting.
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2023
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LA CRESCENTA PRESBYTERIAN CHURCH CTR. FOR CHILDRE
FACILITY NUMBER: 191201896
VISIT DATE: 09/29/2023
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Ratio and staffing were in accordance of Title 22 Code of Regulations at the time of the incident.

LPA referred licensee to resources for dealing with children with challenging behaviors as additional resources for dealing with children with challenging behavior.

Also, LPA Eivazian recommended licensee to call local R&R, CCRC to register for virtual training regarding handling and dealing with children with challenging behaviors and staff that may be beneficial for them to attend.

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when these incident occurred. Therefore, there are no deficiencies being cited on this date.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Julie Larson, Assistant Director at 2:50 p.m..
REPORT END 2 OF 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Anomeh EivazianTELEPHONE: (323) 981-3391
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023
LIC809 (FAS) - (06/04)
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