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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015142
Report Date: 07/09/2019
Date Signed: 07/09/2019 12:09:53 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:PLAZA-LA ROCA VERDE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198015142
ADMINISTRATOR:GRACIELA CEREZOFACILITY TYPE:
850
ADDRESS:702 GERHART AVENUETELEPHONE:
3233697681
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:60CENSUS: 25DATE:
07/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Center DirectorTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at Plaza Roca Verde on 06//19. The Monterey Park Regional Office received the incident report on 06/14/19. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

Based on the information that were gathered through interview and observation, it revealed that, on the day of the incident there were 12 children with 3 teachers. During morning outside time, S1 observed C1 was running down the steps then lost his footing hit his left forehead on the edge of the sink. S1 immediately applied pressure to stop the bleeding. Parents were contacted. Child was taken to the doctor and two stiches were required. Child was able to return school the next day. To prevent other similar incident from reoccurrence, center staff continue redirecting an reminding children to play safe and no running down the steps. At this time based on 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.

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: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
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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