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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007699
Report Date: 07/19/2019
Date Signed: 07/19/2019 04:01:30 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:COLUMBIA PLAZA EARLY CHILDHOOD EDUCATION CENTERFACILITY NUMBER:
198007699
ADMINISTRATOR:QUETA MORALESFACILITY TYPE:
830
ADDRESS:12830 COLUMBIA WAY (CLARK)TELEPHONE:
(562) 803-6229
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:84CENSUS: 55DATE:
07/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Site SupervisorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at Columbia Plaza Early Childhood Education Center on 05/01/19. The facility made the 24 hours self-report on 05/01/19. The Monterey Park SW Regional Office received the writing incident report on 05/03/19. Upon arrival, LPA observed proper care and supervision.

LPA completed child and staff’s records review. LPA obtained child's document, and personnel report.
Based on interviews conducted, it indicated during arrival time at 8:20 AM, grandma and C1 were waiting to be sign in, while a parent was exiting the classroom, C1 ran toward the door. Grandma quickly pulled C1 back as the door closes on C1’s right ring finger. Child fingernail was detached. Staff immediately provided first aid. Mother was contacted. Child was taken to the hospital. Doctor indicated no broken finger. Child returned to school the next day without any restriction, his finger bandaged. At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2019
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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