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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013241
Report Date: 02/13/2025
Date Signed: 02/13/2025 10:59:24 AM

Document Has Been Signed on 02/13/2025 10:59 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ANGELA PRESCHOOL KINDERGARTENFACILITY NUMBER:
198013241
ADMINISTRATOR/
DIRECTOR:
BAOJUAN XUFACILITY TYPE:
850
ADDRESS:5708-5714 N. MUSCATEL AVE.TELEPHONE:
(626) 445-9288
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91775
CAPACITY: 121TOTAL ENROLLED CHILDREN: 121CENSUS: 71DATE:
02/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:03 AM
MET WITH:Jianfang WangTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 02/13/2025, Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management inspection for the purpose to follow up on an unusual incident report. Upon arrival at 10am, LPA met with Facility Representative , Jianfang Wang , to whom the purpose of the inspection was explained. Tour of the facility was provided. There were 71 children, and 12 staff members present upon arrival.

On 01/20/25 an unusual incident report was submitted to the Department regarding a child sustaining an injury on the facility grounds. Child lost their balance hitting their forehead to the rocking horse . Per facility representative stiches were placed on the child`s forehead .

During the visit , LPA toured the facility and observed area where incident took place . Pictures where taken. LPA interviewed Director and two staff members present during the incident. LPA obtained copy of the ouch report and picture taken by the facility .

Staff stated there 8 children and 2 staff members present when incident took place . Staff # 1 stated she observed the incident and saw child #1 lost their balance when was walking towards to the rocking horse . Staff stated it was an accident and happened very quick . Staff stated first aid was provided immediately, parents were notified, and ouch report was created .

Based on the information obtained and observation of the area where incident took place , LPA did not observe any hazards and determined that there was adequate supervision on the day of injury, and it was not possible to prevent the injury from happening. Per California Code of Regulations Title 22, Division 12, no deficiency 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.

Exit interview conducted with the Jianfang Wang , Director and Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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