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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416573
Report Date: 04/09/2024
Date Signed: 04/09/2024 04:07:57 PM


Document Has Been Signed on 04/09/2024 04:07 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WILLIAM R. ANTON EARLY EDUCATION CENTERFACILITY NUMBER:
197416573
ADMINISTRATOR:CYNTHIA CORCOLESFACILITY TYPE:
850
ADDRESS:831 NORTH BONNIE BEACH PLACETELEPHONE:
(323) 981-3670
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:168CENSUS: 61DATE:
04/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sandy GuillermoTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Roxana Lopez and Saul Valenzuela conducted an unannounced Case Management inspection due to 2 incidents that were reported to the Department on 01/30/2024, and 03/08/2024. A COVID 19 risk assessment was conducted. LPAs met with Lead Teacher Sandy Guillermo who guided LPAs on a tour of the facility. Census was taken.

On March 8th, 2024, one incident was self-reported to the Department via Email by the facility who reported a child sustained a head injury.



On January 30th, 2024, one incident was self-reported to the Department via Email by the facility who reported a child sustained a cut lip while in care.

All reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incidents reported to the Department.

During the inspection, LPAs Lopez and Valenzuela conducted interviews with staff. Regarding first incident first aid was administered, child was taken to the doctor for a follow up by authorized representative a week after the head injury incident. The doctor's note stated that symptoms were not related to incident . LPAs observed copies of injury reports. Regarding second incident first aid was administered, child was taken to the doctor for a follow up. Two stitches were needed and no restrictions were given.

During this visit the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Sandy Guillermo.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Saul ValenzuelaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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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