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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197404126
Report Date: 10/22/2019
Date Signed: 10/22/2019 12:01:43 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: 15DATE:
10/22/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Aura OsoyTIME COMPLETED:
12:17 PM
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Licensing Program Analyst (LPA) Isabel Ortega conducted an unannounced case management incident inspection. Upon arrival the LPA was greeted by facility director Aura Osoy who guided the LPA on a tour of the Facility. The purpose of the inspection is in regards to an incident that was self reported to the department, this incident occurred on 10/17/19. Upon arrival 15 children were observed in care.

On 10/18/19 the facility received a call from mom requesting to know if child had hurt himself while in care. Mom stated she took child #1 to the Doctor due to a wound on child's right toe that required medical attention. The doctor released Child #1 to return to school with restrictions of no physical activities and no sand box play from 10/19/19 through 11/02/19.

During todays inspection the LPA reviewed records, obtained copies of roster, interviewed staff and child #1. LPA conducted an inspection of the facility including the outdoor play area and sand play area. The classroom and outdoor play including the sand play area was inspected and was observed to be free of hazards, loose and sharp parts. Children at the center are allowed to remove their shoes if desired and before entering the classroom children's shoes are checked for sand by staff. According to interviews with staff, child #1 was less active than normal and information obtained was inconsistent. Child #1's toe injury can not be determined if it occurred at the facility or at child's home. Therefore, this usual/incident report is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the aforementioned allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, notice of site visit, and appeal rights were provided to Site Director Aura Osoy.

SUPERVISOR'S NAME: Carissa BellTELEPHONE: (661) 789-6953
LICENSING EVALUATOR NAME: Isabel OrtegaTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2019
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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