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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598992
Report Date: 10/22/2021
Date Signed: 10/22/2021 11:45:48 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: 10DATE:
10/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Gwen Blackmon - DirectorTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced case management incident inspection today, due to an incident that occurred on Tuesday 10/19/2021. Upon arrival at 9:40am, LPA met with Director Gwen Blackmon who guided analyst on a tour of the facility.

Census was taken. There were 2 children and 1 staff in Infant #2, 4 children and 1 staff in Infant #3, and 4 infants and 3 staff in Toddler Blue.

Alleged Incident took place on 10/19/2021. Incident was reported via telephone on 10/20/2021. The facility reported the incident within the required 24 hour time frame.

On 10/20/2021, an unusual incident was reported to the Department regarding an incident that took place on 10/19/2021. The incident states that Parent #1 entered the infant classroom to drop off their child and observed Staff #2 put three children down for nap with one additional child on their lap. Parent #1 states that Staff #2 hit Child #1 on the face. Parent #1 immediately reported the incident to Staff #1 when they observed the incident. No staff observed the incident take place. During inspection, LPA observed the classroom where the incident was reported to take place. LPA obtained copies of written statements from Staff #2 and Parent #1. Interviews were conducted with two staff members. Children were not interviewed due to being nonverbal age. Investigation will continue to conduct further interviews and/or obtain additional documentation. Due to insufficient information at this time, a follow up visit will be made at later date.

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 11:40am.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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