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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015614
Report Date: 10/01/2021
Date Signed: 10/01/2021 11:17:19 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:COVINA EDUCATIONAL CENTER STATE PRESCHOOLFACILITY NUMBER:
198015614
ADMINISTRATOR:VANESSA BURGUENOFACILITY TYPE:
850
ADDRESS:160 N. BARRANCATELEPHONE:
(626) 974-4204
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:72CENSUS: 31DATE:
10/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Vanessa Burgueno, DirectorTIME COMPLETED:
11:25 AM
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An unannounced Case Management - Incident visit was held by Licensing Program Analyst (LPA) Thelma Razo and met with teacher Martha Rivera. LPA stated the purpose of the visit is due to Unusual Incident which occurred on 9/24/2021 and was self reported the same day by lead teacher Cristina Angelo to Community Care Licensing Division (CCLD). The Unusual Incident was reported within the required time frame per regulation.

During today's inspection, LPA interviewed staff, and children. LPA toured the center with Director to include preschool playground, 3 preschool classrooms and bathrooms. LPA observed 31 children with 8 staff (4 teachers and 4 aides) at the facility.

No deficiencies were cited in accordance with California Code of Regulations Title 22 at this time.

The Notice of Site Visit (LIC 9213) was posted and must remain 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 conducted, Appeal Rights explained and a copy was given together with the report.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2021
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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