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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015484
Report Date: 12/04/2019
Date Signed: 12/04/2019 10:15:45 AM

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:OAK TREE DAY SCHOOLFACILITY NUMBER:
198015484
ADMINISTRATOR:GASSIA KRIKORIANFACILITY TYPE:
840
ADDRESS:456 W. ORANGE GROVE AVENUETELEPHONE:
(909) 620-1200
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:29CENSUS: 0DATE:
12/04/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Sara KrikorianTIME COMPLETED:
10:15 PM
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AMENDED REPORT TO INDICATE LPA MET WITH DIRECTOR SARA KRIKORIAN ONLY AND NOT GASSIA KRIKORIAN.

Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Case Management-Incident inspection. Licensing Program Analyst met with Director Gassia Krikorian who assisted with the inspection.

LPA interviewed children and staff. LPA also observed children's records, facility roster and other documentation. LPA was unable to interview one child. There were no disclosures made from interviews regarding any allegations or concerns that took place. Based on interviews and documentation, there were no disclosures or information provided to LPA to substantiate any Title 22 violations.

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. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Director Gassia Krikorian.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Warren BirksTELEPHONE: 323-981-3373
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2019
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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