191570934-6-16-2025-33-CC-CTUA-DHPUMS-20250616154250

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191570934
Report Date: 06/16/2025
Date Signed: 06/16/2025 03:43:00 PM

Document Has Been Signed on 06/16/2025 03:43 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	AMAR CHILDREN'S CENTER		FACILITY NUMBER:	191570934
ADMINISTRATOR/ DIRECTOR:	GABRIEL MUNOZ		FACILITY TYPE:	850
ADDRESS:	1000 N. CALIFORNIA AVE.		TELEPHONE:	(626) 933-7101
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY: 384	TOTAL ENROLLED CHILDREN: 384	CENSUS: 161	DATE:	06/16/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Abigail Querubin-Villareal		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 6/16/2025 at 12:55 pm, Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management incident inspection visit due to the facility had reported and submitted an Unusual Incident Report (UIR) of a child who required medical attention. LPA met with Child Development Director, Abigail Querubin-Villareal as Child Development Supervisor (CDS), Gabriel Munoz was not available. LPA obtained a census of 161 children with 38 staff. The facility had reported the incident via email by submitting an Unusual Incident Report (UIR) on May 16, 2025. The incident was reported to the Department within the required 24 hours of occurrence. The incident occurred on May 16, 2025, at approximately 11:20 am in classroom PJ. Child #1 (C1) had suffered a seizure and Staff #1 (S1), and #2 (S2) assisted C1 by making sure they were not injured during the seizure. C1 was placed on her side after the seizure and according to S1, C1 never lost consciousness or stopped breathing, however according to S1 the EMTs did provide oxygen due to low levels and disclosed that C1’s lips had turned a blueish color. Office Assistant, Dennis Quinonez had called the Emergency Medical Technicians (EMTs) who arrived at 11:30 am. The Tosa, Ann Pettersen assisted the staff during the incident and stated that C1’s temperature was checked by the staff and temperature was a normal range. According to S1 the EMTs checked C1’s temperature during their examination at the facility before being transported, as well as at the hospital and found it to be within normal range. CDS also assisted and called the parents of C1 to report the incident, as well as followed up with parents at 4:00 pm to inquire of C1’s condition, but there was no answer. C1 was taken to the local hospital page 1 of 2

NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: AMAR CHILDREN'S CENTER	FACILITY NUMBER: 191570934
	VISIT DATE: 06/16/2025

NARRATIVE

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for evaluation. S1 rode in the ambulance with C1 to the hospital and CDS followed in his own vehicle and C1’s parent arrived shortly after.

According to Child Development Director staff had informed her that at approximately 11:20 am C1 had vomited during lunch time and their eyes had rolled back and child had turned a blueish color. When EMTs arrived at approximately 11:30 am, C1 was responsive and vital signs were good. According to parent this was not C1's first time having a seizure and parent had never disclosed to the facility, however this was the first C1 had suffered a seizure at school. According to the parent C1 had seizures due to a high temperature and a seizure plan will be discussed with parent, as well as updating licensing forms such as Health History and any medical forms.

LPA will follow-up with CDS to obtain a copy of the accident report, and any seizure medical plans however a copy of the Physician’s report was provided during the visit. C1 returned to school on 5/29/2025. According to the TOSA the allergy/medical condition list has been updated and is available for staff in the classroom.

No citations are being issued during today’s inspection visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Child Development Director, Abigail Querubin-Villareal.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/16/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2025

LIC809 (FAS) - (06/04)

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