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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008742
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:34:54 AM


Document Has Been Signed on 10/26/2022 10:34 AM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ANNA BING ARNOLD CHILDREN'S CENTERFACILITY NUMBER:
198008742
ADMINISTRATOR:CARA DALLAMORAFACILITY TYPE:
830
ADDRESS:2301 N. LEVANDA AVE.TELEPHONE:
(323) 343-2470
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:18CENSUS: 6DATE:
10/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:James Goodrich TIME COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 10/17/2022. LPA met with James Goodrich, Assistant Director. LPA was guided on a tour of the infant classrooms. LPA took a census of infants in care. Staff names were obtained. LPA conducted interview and obtained documentation during this visit.

The incident that occurred on Monday, 10/17/22 was reported to the Department on 10/17/22; within the required 24 hours of occurrence. On 10/17/22, an infant in care was fed the incorrect breast milk by a staff member. The child did not have a negative reaction to the breast milk, however, it was an immediate risk to the health and safety of the infant in care. Title 22 Regulation Section 101223 (a)(2)- Personal Rights states that the licensee shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations, to meet his/her needs.

LPA Judy Mora informed Assistant Director, James Goodrich, that this report dated 10/26/22 documents 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Mora informed the Assistant Director to provide a copy of this licensing report dated 10/26/22 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation.Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted with Assistant Director, James Goodrich. Appeal rights explained & provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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Document Has Been Signed on 10/26/2022 10:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: ANNA BING ARNOLD CHILDREN'S CENTER
FACILITY NUMBER: 198008742

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2022
Section Cited

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Personal Rights :The licensee shall ensure that each child is accorded the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by the incident which occurred
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on 10/17/22, when S1 fed an infant the incorrect breast milk.This was an immediate risk to the health and safety of the infant in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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