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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191205095
Report Date: 02/16/2023
Date Signed: 02/16/2023 12:38:58 PM


Document Has Been Signed on 02/16/2023 12:38 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:ALTADENA CHILDREN'S CENTERFACILITY NUMBER:
191205095
ADMINISTRATOR:SHONNA CLARKFACILITY TYPE:
850
ADDRESS:2326 NORTH EL MOLINOTELEPHONE:
(626) 797-6142
CITY:ALTADENASTATE: CAZIP CODE:
91001
CAPACITY:44CENSUS: 31DATE:
02/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Shonna Clark TIME COMPLETED:
12:45 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. Licensing staff met with Director, Shonna Clark. Census was taken.

On 2/03/2023, an unusual incident report was made to the department involving possible violation of a child personal rights while in care. The facility reported this incident to the Department within the required 24 hours. Per Director, on 02/04/2023 a parent alleged that their child personal rights were violated while in care. During this inspection, LPA conducted (4) staff interviews regarding the allegation and the incident that occurred on 02/03/2023. Based on the information obtained, there is not enough preponderance of evidence to substantiate the allegation of a child’s personal rights being violated while in care. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's inspection.

A notice of site visit 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 Director, Shannon Clark.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Crystal GreenTELEPHONE: (323) 980-4930
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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