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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 07/13/2022
Date Signed: 07/13/2022 10:56:42 AM


Document Has Been Signed on 07/13/2022 10:56 AM - It Cannot Be Edited

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: 31DATE:
07/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Maria Birrutea, Site SupervsiorTIME COMPLETED:
10:45 AM
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On July 13, 2022, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the purpose of verifying that uncleared Staff #1 is not within the facility. Although, Staff #1 was fingerprinted, association has not been completed, as fingerprints still show "In Process". Therefore, the uncleared staff #1 may not be in the facility until cleared and association is complete. Upon arrival, LPA was greeted by Site Supervisor, Maria Brriutea who guided LPA on tour of the facility. LPA observed 31 children in care with 7 staff.

Site supervisor was reminded about regulations of any adult over the age of 18 years old working in the facility must be fingerprint cleared and associated.

There are no deficiencies cited today.

An exit interview was conducted, a copy of this report , appeal rights and notice of site visit was provided to site supervisor on this day.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/13/2022
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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