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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570862
Report Date: 11/19/2020
Date Signed: 11/19/2020 05:30:36 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RAMONA SCHOOLFACILITY NUMBER:
191570862
ADMINISTRATOR:LAUREL PARKERFACILITY TYPE:
850
ADDRESS:14616 DINARDTELEPHONE:
(562) 210-4205
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:375CENSUS: DATE:
11/19/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cynthia Allen, Assistant DirectorTIME COMPLETED:
03:00 PM
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Due to COVID-19 and precautionary measures, Licensing Program Analyst (LPA) T. Tran delivered the Incident Report by use of via email to Cynthia Allen, Assistant Director on 11/23/2020.

Licensing Program Analyst (LPA) T. Tran conducted a Case Management Incident by via telephone to follow up on a self-reported incident on 12/17/2019 involved two enrolled children were having a conflict over toys then C2 bit C1 on the left upper back. Staff immediately intervened and redirected both children. Both parents were contacted. No medical attention required. Therefore, this incident was not result in the Title 22 Regulations for Lack of Care and Supervision violation. No deficiency was cited.

Exit interview was conducted with the noted person by via telephone during which appeal rights were explained. This report along with a copy of the appeal rights will be sent to licensee by via email with a read receipt or confirmation of receipt of email, which will act as the Assistant Director's signature.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2020
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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