<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570967
Report Date: 01/26/2024
Date Signed: 01/26/2024 12:52:56 PM


Document Has Been Signed on 01/26/2024 12:52 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:TRACY INFANT CENTERFACILITY NUMBER:
191570967
ADMINISTRATOR:TOM WOODWARDFACILITY TYPE:
830
ADDRESS:12222 CUESTA DRIVE, BLDG FTELEPHONE:
(562) 229-7762
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:62CENSUS: 5DATE:
01/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Dr. Rebecca LynchTIME COMPLETED:
01:10 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
Licensing Program Analysts (LPAs) T. Tran and C. Kam conduct an unannounced Case Management Incident visit at Tracy Infant Center to follow up self-reported incident occurred on 12/14/2023 regarding care and supervision. The Monterey Park Southwest Office received the writing report on 12/14/2023. LPAs met with Dr. Rebecca Lynch, Supervisor Child Development and Special Program. LPAs observed proper care and supervision.

LPAs completed child and staff files review. LPA obtained child's document, parent's sign in/out attendance, and personnel report. Interviews were conducted with staff and other. On 12/14/23, there were 7 children with three teachers. The fire drill was conducted around 10:52AM and lifted around 11:03AM, upon returning to the class staff discovered C1 was left alone in the classroom napping without any adult supervision. Parent was notified of the incident. Based on the available information it appears this incident was the result of a Title 22 violation for lack of care and supervision.

on 12/19/23, facility representative had completed individual training with all center staff. New directives to improve the health and safety for all enrolled children had been implemented in the classroom. During today's visit, LPAs obtained the training materials for the records and observed the counting board in each classroom. Plan of Correction had been correction upon today's visit.

Type A deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Dr. Rebecca Lynch.

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 01/26/2024 12:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: TRACY INFANT CENTER
FACILITY NUMBER: 191570967

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2024
Section Cited
CCR
101429(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision for Infants
This requirement is not met as evidenced by based on record review and interviews on 12/14/23 facility failed to provide adequate care for C1, during the fire drill C1 was left alone napping in the infant room for about
1
2
3
4
5
6
7
During today's visit, LPAs obtained training record provided by the facility representative with individual staff regarding to care and supervision. POC cleared 1/26/24.
8
9
10
11
12
13
14
10 minutes without any adults superivison which poses a
potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2