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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870874
Report Date: 05/23/2022
Date Signed: 05/23/2022 04:54:04 PM


Document Has Been Signed on 05/23/2022 04:54 PM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:MOUNT ST. MARY'S CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191870874
ADMINISTRATOR:WENDY GALANFACILITY TYPE:
850
ADDRESS:10 CHESTER PLACETELEPHONE:
(213) 477-2977
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:74CENSUS: 26DATE:
05/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:09 PM
MET WITH:Wendy Galan, DirectorTIME COMPLETED:
05:01 PM
NARRATIVE
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Licensing Program Analyst Mayra Rivera conducted an unannounced Case Management Inspection. LPA met with Director Wendy Galan who guided the LPA on a tour of the facility.

Based on file review observation and information provided by Director, Staff 1 does not have a background clearance. Staff 1 has been present at the facility and present during LPA Rivera visit. LPA informed Director Wendy, Staff 1 cannot be present at the facility until Staff 1 has a background clearance.

Based on the available information it is a result of a Title 22 violation for having a staff member present during hours of operation without a background clearance. The facility has been cited Type A and given a deficiency.

The content of this report was read and discussed and an exit interview was conducted with Director Wendy Galan and the notice of site visit must be posted for 30 days upon receipt and appeal rights were given and explained.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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


Document Has Been Signed on 05/23/2022 04:54 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: MOUNT ST. MARY'S CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191870874

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2022
Section Cited

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility.

This requirement is not met as evidenced by:
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Based on LPA observation at 4:04 p.m. staff 1 does not have a background clearace which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
LIC809 (FAS) - (06/04)
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