<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197492776
Report Date: 10/20/2020
Date Signed: 10/20/2020 11:51:13 AM

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:TUTOR TIME CHILD CARE LEARNING CENTERFACILITY NUMBER:
197492776
ADMINISTRATOR:SERRANO, ANGELICAFACILITY TYPE:
840
ADDRESS:23041 NEWHALL RANCH ROADTELEPHONE:
(661) 263-2655
CITY:SANTA CLARITASTATE: CAZIP CODE:
91350
CAPACITY:30CENSUS: 10DATE:
10/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Angie Serrano, Director TIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Monique Ayala conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 10/16/20; this incident was reported timely. LPA spoke with Director. Due to COVID-19 Emergency Response this inspection was conducted virtually. LPA virtually toured the facility and took a census of the children. Upon arrival, there were 15 children and 2 staff present today at the facility.

Description of the incident: An incident on 10/15/20 at approximately 3:00pm, child #1 (child's name on LIC 811) walked into the restroom avoiding some liquid (urine) on the floor slipped, hitting his left eye (red spot over his eyebrow). Teacher #1 (teachers name on LIC 811) saw the incident. Director requested child be taken to the doctor.

LPA obtained a copy of the facility roster and staff phone numbers. LPA received pictures from director where the incident took place.

A final determination has not been made and further investigation is needed. No citations are being issued on this date. This Unusual Incident was reported timely to the Palmdale Regional Office.

An exit interview was conducted and a copy of this report was read and will be provided to the director via email on 10/20/2020.
SUPERVISOR'S NAME: Mariela RamonTELEPHONE: (661) 369-2168
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: (661) 202-3365
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
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 1