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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013662
Report Date: 01/07/2020
Date Signed: 01/07/2020 03:46:09 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:CURTIS CARE INFANT DEVELOPMENT PROGRAMFACILITY NUMBER:
198013662
ADMINISTRATOR:LUCINA MENAFACILITY TYPE:
830
ADDRESS:12114 PARAMOUNT BOULEVARDTELEPHONE:
(562) 869-0646
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:25CENSUS: 19DATE:
01/07/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Program DirectorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Tiffanie Tran conducted a Case Management inspection at the above facility to follow up on the self-reported incident that occurred on 12/13/2019. The Monterey Park South West Child Care Regional Office received the incident report on 12/17/2019. Reporter stated, during afternoon outdoor play, C1 was climbing down from the apparatus and lost his balance then hit his head caused a laceration on the back of his head. Medical care required.

LPA completed children and staff records review. LPA obtained personnel report and child document. Staff and children were interviewed.

Based on available information, on the day of the incident there were three teachers with nine children in care. S1 stated, during afternoon outside time, C1 was climbing down apparatus, while his twin brother was trying to go up. S1 stopped the twin brother go up to allow time for C1 to climb down then observed C1 lost his balance then fell back hitting the back of his head on the apparatus board. C1 sustained a small laceration on the back of his head. Mother was contacted. Child received one stitches. Child did not miss any day of school. Child observed to be normal. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

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: 01/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2020
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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