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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191596182
Report Date: 06/25/2024
Date Signed: 06/25/2024 01:17:50 PM

Document Has Been Signed on 06/25/2024 01:17 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:CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191596182
ADMINISTRATOR/
DIRECTOR:		TAMIKA ADDISONFACILITY TYPE:
850
ADDRESS:1100 N. GRAND AVE., BLDG. 70TELEPHONE:
(909) 274-4920
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 182TOTAL ENROLLED CHILDREN: 22CENSUS: 16DATE:
06/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:40 PM
MET WITH:Lupe Hernandez, Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 06/25/2024, Licensing Program Analysts (LPAs) Kruz Long and Priscilla Ochoa conducted an unannounced case management inspection. A COVID-19 risk assessment was conducted. LPAs met with Lupe Hernandez, Assistant Director and explained the purpose of the visit. There are 22 children enrolled in classroom 1400. 16 children and 5 staff members were present in the classroom.

The purpose of the visit is to follow up on an incident that occurred on 06/13/2024 and was reported to the department on 06/14/2024. The self reported incident is regarding supervision and physical environment.

During today's inspection, LPAs toured the classroom with the Assistant Director and interviewed Staff #1 (S1) and Staff #2 (S2).

Based on interviews with S1 and S2, there were no corroborating information to determine that there was a lack of supervision during this incident. LPA toured the classroom where the incident occurred and did not observe any tripping hazards. The facility is not being cited any deficiencies today.

An exit interview was conducted and a copy of this report and appeal rights was provided to the Assistant Director.

A Notice of Site Visit was provided. Notice of Site Visit must be posted for 30 days.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Kruz Long
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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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