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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016445
Report Date: 06/18/2019
Date Signed: 06/18/2019 11:21:24 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:KID TOWN USA PRESCHOOL-MONTESSORI ACADEMYFACILITY NUMBER:
198016445
ADMINISTRATOR:HARSHI ANTONYFACILITY TYPE:
850
ADDRESS:13500 PARAMOUNT BLVD.TELEPHONE:
(562) 630-0400
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:144CENSUS: 72DATE:
06/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ernestina CoronelTIME COMPLETED:
11:40 AM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Raul Navarro to address an Unusual Incident Report that was received in the licensing office on 05/09/2019. LPA met with Director Ernestina Coronel who guided LPA on a tour of facility of both indoors and outdoors.

On 05/09/19 child #1 went over and poked child #2 in the private area. The children were playing in the playground within the supervision of teacher #1. Teacher #1 reported the incident to teacher #2 who informed Director. Child #2 did not sustain any injuries. No medical attention was required.

Director informed the parents of child #1 and child #2 of the incident. Per Staff, there has not been any other incidents with Child #1.

Based on all information obtained on this date, and interviews conducted with staff, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.

Exit interview was conducted with Director Ernestina Coronel . The Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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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