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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191205095
Report Date: 05/09/2019
Date Signed: 05/09/2019 02:22:16 PM

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:ALTADENA CHILDREN'S CENTERFACILITY NUMBER:
191205095
ADMINISTRATOR:BOUCHER, TONIFACILITY TYPE:
850
ADDRESS:2326 NORTH EL MOLINOTELEPHONE:
(626) 797-6142
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:44CENSUS: 38DATE:
05/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Toni BoucherTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Ariel Cazares conducted an unannounced case management inspection for the purpose of following up on incidents reported to the Department. LPA met with Director Toni Boucher, who guided analyst on a tour of the facility. LPA observed a total of 38 children and 4 staff in 3 classrooms.

On 3/4/19 and 3/8/19 two separate incidents occurred in the facility where two children sustained injuries on a play structure located in the preschool playground. On 3/4/19, Child #1 was going up the steps of the play structure, then fell causing a cut to his chin. The child received medical attention and the cut was glued closed. On 3/8/19, Child #2 was climbing up the play structure when he fell off onto his feet. The child received medical care for a sprain. Children's files were reviewed and accident reports observed.

LPA interviewed Staff #1 who observed Child #1's incident. Per staff, there was adequate supervision and they were in compliance with staff-child ratios. Staff #1 stated that she observed child running quickly up the steps and then fall. Staff #1 stated the child's parent was also present and they both assisted child with first aid. Staff #2 who was present for Child #2's incident was not available for an interview. LPA will contact staff for interview at a later time. LPA will return should any additional information obtained determine a violation.

LPA inspected the outdoor playground and the play structure where both children were injured. LPA did not find any loose parts, any need for repair that could have caused the slips, or any hazards that would have resulted in the injuries. LPA observed the structure to be in clean and good condition, with no need for repair. At this time LPA did not find any violations that resulted in the incidents or as a result from the incidents.

Exit interview conducted with Director Toni Boucher. A copy of this report was provided. A "Notice of Site Visit" and copy of the report was issued. Notice of Site Visit must remain posted for 30 days. Failure to do so will result in a $100.00 civil penalty.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Ariel AlmazanTELEPHONE: (323) 981-2949
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2019
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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