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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191205095
Report Date: 07/16/2019
Date Signed: 07/16/2019 01:00:55 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: DATE:
07/16/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Toni BoucherTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Crystal Green conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 07/12/2019. LPA met with Kathy Pursel, Adminstrator until Toni Boucher, Director arrived shortly after. Census was taken.

On 07/12/2019, an unusual incident report was made to the department where a parent alleges that child's personal rights were violated while in care. The facility reported this incident to the Department within the required 24 hours of being informed. The purpose of the inspection was to obtain additional information regarding the allegation reported to the department. During inspection, LPA obtained the contact information for the parent and obtained documents information regarding the allegation. Due to insufficient information being available at this time, a follow up visit will be required at a later date.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Director.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-2956
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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