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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004424
Report Date: 09/13/2019
Date Signed: 09/13/2019 05:17:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COVENANT KIDS PRESCHOOLFACILITY NUMBER:
198004424
ADMINISTRATOR:DANDY DEPAULAFACILITY TYPE:
850
ADDRESS:21209 S. CLARETTATELEPHONE:
(562) 402-8330
CITY:HAWAIIAN GARDENSSTATE: CAZIP CODE:
90716
CAPACITY:48CENSUS: 12DATE:
09/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Dandy De Paula, DirectorTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Rita Ramos and Fabiola Vasquez conducted an unannounced case management inspection to the above facility. LPAs met with Dandy De Paula, Director, who guided analysts on a tour of the facility. There were 12 children with 3 staff upon arrival.

The purpose of this inspection was to review the Caregiver Background Check Bureau letter that was sent to the Licensee for the Non-Exemptible Conviction of Henry Trimble dated August 14, 2019, and to ensure that the individual named is no longer working and/or volunteering at the facility. The purpose of the inspection was discussed with Dandy De Paula and a copy of the Non-Exemptible Conviction letter was provided to Dandy De Paula during the inspection.

LPAs obtained a signed Confirmation of Removal for Henry Trimble during today’s visit.

Based on the evidence obtained during today’s visit, LPAs have verified that the individual Henry Trimble is not present, employed, or volunteering at the facility. LPAs has advised the Director to disassociate the individual from their roster and submit an updated LIC 500-Personnel Report. Per Director, Henry Trimble was not added to the LIC 500 because they never commenced working/volunteering at the facility. Verification of Removal is complete.

There were no deficiencies cited during today’s visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Dandy De Paula, Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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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