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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007699
Report Date: 11/23/2021
Date Signed: 11/23/2021 02:36:58 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:COLUMBIA PLAZA EARLY CHILDHOOD EDUCATION CENTERFACILITY NUMBER:
198007699
ADMINISTRATOR:QUETA MORALESFACILITY TYPE:
830
ADDRESS:12830 COLUMBIA WAY (CLARK)TELEPHONE:
5628036229
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:84CENSUS: 30DATE:
11/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Patricia Arrua, Site SupervisorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) T. Tran arrived at Columbia Plaza Early Childhood Ed. Center to conduct an unannounced Case Management inspection that was self-reported on 10/22/2021 regarding a child in care fell and sustained a bump/bruise on the forehead. The Monterey Park South West Child Care Regional Office received the incident report on 10/28/2021. About 11:35 AM, Site supervisor provided LPA a tour of the facility. LPA observed proper care and supervision.

LPA completed files review for staff, children, and obtained child's record. Based on the information that were gathered through interviews with staff and other. On the day of the incident, there were two staff supervised 6 children. According to the available information, it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representatives, Patricia Arrua.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2021
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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