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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191594162
Report Date: 12/22/2022
Date Signed: 12/22/2022 10:38:57 AM


Document Has Been Signed on 12/22/2022 10:38 AM - 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:ALMANSOR CENTER (THE)FACILITY NUMBER:
191594162
ADMINISTRATOR:TAMERA PINELOFACILITY TYPE:
850
ADDRESS:1955 FREMONT AVENUETELEPHONE:
(323) 341-7768
CITY:SOUTH PASADENASTATE: CAZIP CODE:
91030
CAPACITY:60CENSUS: 31DATE:
12/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Teacher, Blanca GomezTIME COMPLETED:
10:45 AM
NARRATIVE
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On December 22, 2022 at 8:30AM Licensing Program Analyst (LPA) Bardo Baluyot conducted an unannounced Case Management Inspection–Deficiencies at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Teacher, Blanca Gomez who guided LPA on a tour of the facility. LPA observed children in care, at 9 AM. Director, Tamera Pinelo arrived a short time later.

The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and cite a deficiency discovered during the course of a complaint investigation concluded on 11/29/2022. (Complaint # 33-CC-20221108093243)

LPA verified with Director/Staff #1 (S1) and Staff #5 (S5) that (S1) did not report incident to Licensing. Based on LPA's verification of Licensing records and S1's own admission, S1 did not report the incident to Licensing as a UIR within 24 hours of the incident. Additionally, S1 stated that this was per the directive of Licensee's Human Resources Department due to an ongoing legal/insurance claim RP/P1 has filed against the facility.

Based on the above information, facility is found to be in violation of Reporting Requirements and a Type B deficiency is being cited today, 12/22/2022. Please see LIC809D.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

An exit interview was conducted, and a copy of this report was provided to Director, Tamera Pinelo. A copy of Appeal Rights were also provided to licensee and explained that the licensee has 15 days from the day of citation (12/22/2022) to file an appeal to the department.

SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
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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Document Has Been Signed on 12/22/2022 10:38 AM - 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ALMANSOR CENTER (THE)
FACILITY NUMBER: 191594162

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2022
Section Cited

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REPORTING REQUIREMENTS:
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1)(B) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information
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Director will ensure that an Unusal Incident Report will be submitted within 24 hours.
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specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any injury to any child that requires medical treatment. This requirement was not met as evidenced by staff disclosure and FAS review. The injury/incident involving the sno cone machine was not reported to licensing as required. This is a potential risk to the health and safety of children in care.
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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: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2022
LIC809 (FAS) - (06/04)
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