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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596182
Report Date: 12/02/2019
Date Signed: 12/02/2019 05:51:50 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191596182
ADMINISTRATOR:TAMIKA ADDISONFACILITY TYPE:
850
ADDRESS:1100 N. GRAND AVE., BLDG. 70TELEPHONE:
(909) 274-4920
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY:182CENSUS: 54DATE:
12/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:41 PM
MET WITH:Director-Tamika Addison and Assistant Director-
Guadalupe Hernandez
TIME COMPLETED:
06:00 PM
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Licensing Program Analysts (LPAs) Alanna Gontarek and Mireya Garcia conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 11/05/2019. Upon arrival, LPAs met with Assistant Director, Guadalupe Hernandez, who provided LPAs a tour of the facility inside and outside. Census was taken.

On 11/05/19, an incident was reported to the Department where a child #1 had an Injury to the ring finger. The facility reported this incident to the Department within the required 24 hour period. Upon arrival, during the walk through of the facility, LPA Alanna Gontarek observed a preschool classroom playing in the front play yard with wooden planks. Supervision was observed to be sufficient during this time. Per Director, and Assistant Director, Child #1 returned to the classroom the following day. During this inspection, LPA was able to observe outside play with the wooden planks. LPAs determined there was adequate supervision provided the day of the incident. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

Exit interview conducted with the Director, Tamika Addison and Assistant Director, Guadalupe Hernandez.

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.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-8417
LICENSING EVALUATOR NAME: Alanna GontarekTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019
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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