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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570862
Report Date: 08/25/2020
Date Signed: 09/04/2020 04:26:17 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:
5622104205
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:375CENSUS: 0DATE:
08/25/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Cynthia Allen, Assistant DirectorTIME COMPLETED:
04:30 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 09/04/2020.

Licensing Program Analyst (LPA) T. Tran conducted a Case Management Incident by via telephone to follow up on a self-reported incident on 11/21/2019 regarding a child stated a teacher pulled child by the arm. The Monterey Park South West Child Care Regional Office received the incident report on 11/22/2020.

Based on the available information that were gathered through interviewed, during transition of nap time, C1 was jumping off the furniture and landed on the carpet while staff and children were setting up the cots. To prevent child from getting hurt, S2 held child's hand and helped child moved to a safer area. C1 refused S2 assisting then stated S2 pulled child's arm. There were no signs that C1 sustained any injuries or discomfort. DCFS was reported and there was no open case for this incident.
At this time based on the available information it does not appear this incident was the result of a Title 22 violation for Personal Rights. 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 the Assistant Director 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: 08/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020
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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