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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890442
Report Date: 01/10/2022
Date Signed: 01/10/2022 01:23:18 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:PINEWOOD AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191890442
ADMINISTRATOR:RACHEL MERMELLFACILITY TYPE:
850
ADDRESS:7051 VALMONT STREETTELEPHONE:
(818) 352-4469
CITY:TUJUNGASTATE: CAZIP CODE:
91042
CAPACITY:96CENSUS: 26DATE:
01/10/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Ani Nicholas, PrincipleTIME COMPLETED:
02:02 PM
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On 01/10/2022, Licensing Program Analyst (LPAs) Liana Stepanyan and Monique Ayala met with Ani Nicholas (Principle) who guided LPAs on a tour of the facility. Upon arrival, LPAs observed 26 children under care and supervision with 12 staff members. The purpose of this visit was to conduct a Case Management (inspection) regarding an unusual incident that occurred at the facility on 12/06/2021 and was received at the Department on 12/07/2021. The unusual incident indicated that on 12/06/2021, staff #1 inflicted scratches on child #1’s back.

On today’s inspection, LPAs interviewed, staff, children and parent. During interviews, there was no disclose of staff #1 scratching child #1’s back.

Based on observations and interviews no citations are being issued. The facility is found to be in compliance with Title 22 regulations.

An exit interview was conducted and copy of this report and notice of site visit was provided to Ani Nicholas (Principle).

SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 202-3798
LICENSING EVALUATOR NAME: Liana StepanyanTELEPHONE: 661-202-3380
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2022
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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