191598992-9-8-2021-33-CC-NTCG-C6NP2L-20210908105607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191598992
Report Date: 09/08/2021
Date Signed: 09/08/2021 10:56:11 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 SCHOOL		FACILITY NUMBER:	191598992
ADMINISTRATOR:	GWEN BLACKMON		FACILITY TYPE:	830
ADDRESS:	300 W. HUNTINGTON DRIVE		TELEPHONE:	(626) 574-3524
CITY:	ARCADIA	STATE: CA	ZIP CODE:	91007
CAPACITY:	55	CENSUS: 21	DATE:	09/08/2021
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Gwen Blackmon- Director		TIME COMPLETED:	10:55 AM

NARRATIVE

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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced in person Case Management – Deficiencies inspection. Upon arrival at 9:45am, LPA was met by Director Gwen Blackmon, to whom the purpose of the inspection was provided. LPA was provided a tour of the facility at 9:50am.

Census was taken. There were 2 children and 1 staff in Infant #2, 4 children and 2 staff in Infant #3, 7 children and 2 staff in Toddler Room, and 8 children and 2 staff in Green Room.

During an investigation, facility was visited by Arcadia Police Department during operation hours. According to documentation from Arcadia Police Department, a visit was conducted on 07/16/2021. LPA’s interviews with staff confirmed that an officer had visited the facility. The visit from Arcadia Police Department was not reported to the Department. Facility’s failure to report the above incident is a violation of Title 22 regulations.

Please see attached Advisory Note for documentation of Technical Violation.

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.

Exit interview was conducted with Director Gwen Blackmon, at 10:40am, including copy of report.

END OF REPORT

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan Tcheng	TELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2021

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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