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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404126
Report Date: 07/18/2019
Date Signed: 07/18/2019 05:10:17 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:SAN FERNANDO GARDENS CHILD CARE CENTERFACILITY NUMBER:
197404126
ADMINISTRATOR:AURA OSOYFACILITY TYPE:
850
ADDRESS:10896 LEHIGH AVE.TELEPHONE:
(818) 834-7874
CITY:PACOIMASTATE: CAZIP CODE:
91331
CAPACITY:24CENSUS: 9DATE:
07/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Aura OsoyTIME COMPLETED:
05:09 PM
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Licensing Program Analyst (LPA) Ortega met with Supervisor Aura Osoy, for a Case Management Incident inspection involving an Incident Report dated July 15, 2019. The incident occurred on July 11, 2019.


Description of the incident: Child #1 personal rights violated by Staff #4
During the inspection interviews were conducted with staff. Child #1 was not present at this time.

Based on information provided and interviews conducted the incident needs further investigation.

An exit interview was conducted and a copy of this report was read and provided to the Supervisor Aura Osoy on this date.
SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2019
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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