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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013724
Report Date: 05/25/2022
Date Signed: 05/25/2022 03:47:44 PM


Document Has Been Signed on 05/25/2022 03:47 PM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:NUFFER ELEMENTARYFACILITY NUMBER:
198013724
ADMINISTRATOR:SHERRY HERRERAFACILITY TYPE:
850
ADDRESS:14821 JERSEY AVENUETELEPHONE:
(562) 210-4079
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:24CENSUS: 16DATE:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Loretta Gallegos, Assistant DirectorTIME COMPLETED:
04:10 PM
NARRATIVE
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The Licensing Program Analyst (LPA), T. Tran, conducted a site visit to follow up a case management incident occurred on 01/11/22. About 12:15PM, LPA met with Loretta Gallegos, Assistant Director and toured the facility inside and outside.

LPA completed child’s review, obtained child's document and personnel report. Staff files located at the main office, LPA will arrange another visit for files review. Children, staff, and other members were interviewed.

Based on information gathered through interviews, on 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes. Per interviewed staff they failed to count the children when transition from outdoor play to the classroom. Within that moment, parent of C1 arrived and staff noticed child was not in the classroom and that same time child saw dad and came out from the Caterpillar from the yard. Child observed to be no harm by this incident. Based on the observation, the facility was double gated and child was still within the premises of the school. Therefore, the facility is being cited for lack of care and supervision.

Type B 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 representative, Loretta Gallegos.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/25/2022 03:47 PM - 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: NUFFER ELEMENTARY
FACILITY NUMBER: 198013724

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/01/2022
Section Cited

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Responsible for Providing Care and Supervision. This requirement is not met as evidenced by based on interviews conducted facility failed to provide proper care for a child enrolled. On 1/11/2022 about 3:30PM C1 was left alone at the enclosed play yard for about 1 to 2 minutes which poses a potential health and safety risk to children 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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2022
LIC809 (FAS) - (06/04)
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