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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598992
Report Date: 11/12/2021
Date Signed: 11/12/2021 01:55:03 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: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: 12DATE:
11/12/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Gwen Blackmon - DirectorTIME COMPLETED:
02:03 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 10/20/2021. Upon arrival, LPA met with Director Gwen Blackmon at 11:25am, who provided LPA a tour of the facility.

Census was taken. There were 3 children and 1 staff in Infant #2, 5 children and 2 staff in Infant #3, 4 children and 2 staff in Toddler Room, and 0 children and 0 staff in Green Room.

During course of today's investigation, LPA conducted interviews with four staff members. Staff made no new disclosures regarding the incident that occurred and disclosed no new information regarding Staff #2's interaction with children in care. Interviews were also conducted with two parents. Parents made no disclosures regarding the nature of the incident reported to the Department on 10/20/2021. Parents stated that ouch reports are provided to the parents at pick up and they have had no issues with the reports provided from the facility. LPA obtained copies of ouch report charts for the group in Infant #3 dating from 06/2021 to present. Ouch reports were reviewed for all injuries to children in care involving Staff #2's name. Per Staff #1, copies of ouch reports are provided to parents upon pick up the day of. Licensing staff conducted staff file review for Staff #2 (S2). LPA did not observe any documentation of reprimand or discipline for S2 in the Staff file. Staff #1 has stated there have been no issues or write ups that they can remember for S2. LPA has also has copies of new staff schedule for the facility as well as a signed copy of Infant/Toddler Meeting agenda regarding a child's personal rights and age appropriate discipline.

Based on observation, the documents obtained during the investigation, and the interviews conducted with staff and parents, there is not a preponderance of evidence to determine that there was violation of Title 22 regulations.

REPORT CONTINUES PAGE 1 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
VISIT DATE: 11/12/2021
NARRATIVE
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Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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 conducted with the Director Gwen Blackmon at 1:50pm. A copy of this report was provided.

REPORT ENDS PAGE 2 of 2
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2