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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 02/21/2020
Date Signed: 02/21/2020 03:20:50 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:CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)FACILITY NUMBER:
191806528
ADMINISTRATOR:VERONICA MONTANO SANCHEZFACILITY TYPE:
850
ADDRESS:4601 SUNSET BOULEVARDTELEPHONE:
(323) 361-4601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY:89CENSUS: 59DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Veronica Montano Sanchez, Site SupervisorTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Janeth Chavez conducted an unannounced case management inspection due to 4 incidents that were reported to the Department. LPA met with Veronica Montano Sanchez & Maria Birrueta, Site Supervisors, who guided LPA on a tour of the facility. There are 59 children present and 9 staff upon arrival.

LPA conducted interviews and obtained documentation during this visit. The incident that occurred on 01/27/20, was reported to the Department on 01/27/2020, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. Information reported to the Department indicated that Child #1 was left inside the classroom during transitioning to the playground by Staff #1 & #2.

The incident that occurred on 10/29/19, was reported to the Department on 10/29/2019 via telephone. The facility reported the Unusual Incident within the required 24 hours of occurrence. Information reported to the Department indicated that a car crashed into the back gate of the playground where the sandbox is located. No children were injured or near the sandbox.

The incident that occurred on 09/17/2019 was reported to the Department on 09/16/2019 via telephone. The facility reported the Unusual Incident within the required 24 hours of occurrence. Information reported to the Department indicated that Child #1 was left in the hallway for approximately 50 seconds during transition to the playground.

The incident that occurred on 08/16/2019 was reported to the Department on 08/16/2019 via telephone. The facility reported the Unusual Incident within the required 24 hours of occurrence. Information reported to the Department indicated that Child #2 sustained an injury that required medical attention.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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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: CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)
FACILITY NUMBER: 191806528
VISIT DATE: 02/21/2020
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Based upon information received from the interviews conducted and copies of documentation obtained it was determined that for the incident that occurred on 01/27/2020 staff was present, observed and had visual observation of Child #1 when the incident occurred. There was no violation of Title 22.

Based upon information received from the interviews conducted and information obtained it was determined that for incident that occurred on 10/29/2019 there were no children in the sandbox and no children were injured. Also, staff were present when the incident happened. There was no violation of Title 22.

Based upon information received from the interviews conducted and documents obtained it was determined that for incident that occurred on 09/17/2019 in which Child #2 was left unsupervised in the hallway for approximately 55 seconds, staff interviewed disclosed that Staff #1 counted before exiting the building and again before entering the playground and realized a child was missing. Staff #1 received a written warning and is no longer employed at the facility. LPA was provided with a written statement by Staff #1 indicating that incident was observed and the child was brought to the playground by a parent. There was no violation of Title 22.

Based upon documents obtained it was determined that for incident that occurred on 08/16/2019 in which Child #2 sustained an injury on his forehead and was bleeding, Site Supervisor and Staff #2 were present and observed the incident. Child #2 was aided, the parents and 911 were called. The child was transported via ambulance to the emergency room. There was no violation of Title 22.

There are no deficiencies cited on today’s inspection. 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.

Exit interview was conducted with Veronica Montano Sanchez, Site Supervisor, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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