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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598992
Report Date: 10/10/2019
Date Signed: 10/10/2019 10:20:39 AM

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:KATHY KREDEL NURSERY SCHOOLFACILITY NUMBER:
191598992
ADMINISTRATOR:GWEN BLACKMONFACILITY TYPE:
830
ADDRESS:300 W. HUNTINGTON DRIVETELEPHONE:
(626) 574-3524
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY:55CENSUS: 14DATE:
10/10/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Gwen BlackmonTIME COMPLETED:
09:51 AM
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Licensing Program Analyst (LPA) Roxana Lopez and Ariel Cazares conducted a plan of correction inspection on this date. The purpose of this inspection was to follow up on cited deficiencies and ensure these deficiencies were corrected in a timely manner. Upon arrival LPA met with Director Gwen Blackmon and observed 14 children.

An inspection was conducted on 10/03/19. The facility was cited for the following:
101217 (a) (11)- Staff 1-4 were missing health screening on file
1596.7995 (c)- Staff 1-4 were missing complete immunization record on file
101161 (a)- Two preschool age children were enrolled in the infant program

The director was advised that corrections were required. LPAs found that the plan of corrections have been met. There were no deficiencies observed on this date. An exit interview was conducted with Director Gwen Blackmon. A copy of this report and appeal rights were distributed and explained.

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: Christina GabelmanTELEPHONE: (323) 513-3677
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019
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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