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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016683
Report Date: 11/04/2021
Date Signed: 11/04/2021 10:10:10 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:DOVE DAY SCHOOLFACILITY NUMBER:
198016683
ADMINISTRATOR:JACQUELINE ALMEIDAFACILITY TYPE:
830
ADDRESS:908 W. ARROW HIGHWAYTELEPHONE:
(909) 599-2299
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:24CENSUS: 2DATE:
11/04/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Tracy Martinez, DirectorTIME COMPLETED:
10:15 AM
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An unannounced Case Management visit was conducted on this date by Licensing Program Analyst (LPA) Bardo Baluyot following a COVID outbreak reported to CCLD on 10/25/21. LPA conducted a COVID risk assessment prior to entry and temperature was taken by staff Ms.Garcia. Upon arrival, LPA was greeted by Director, Tracy Martinez.

Census: There were 2 infants present and school age children do not start arriving until 1:30 pm. Staff-child ratio was met.

During today's inspection, Director guided the LPA on a tour of the entire facility including all classrooms, restrooms, kitchen and outdoor areas as she did on 11/1/21 with DPH Nurse, Christopher Kang. LPA observed all staff and children over two years of age wearing masks. LPA also observed all staff and parents to be following DPH guidelines regarding cleaning and daily entry screening guidelines. An interview was conducted with the Director (Staff #1) and current roster and DPH line list was obtained by the LPA. Per Director, 1 additional school age child tested positive and was traced to having direct contact with the initial positive case reported. Director added that both children who initially tested positive returned today and classrooms will re-open Monday.

No deficiencies cited today and the facility is in compliance with Title 22. Upon receipt, Director Tracy Martinez posted the Notice of Site Visit. The Notice of Site Visit shall be posted for thirty (30) consecutive days. Failure to maintain posting as required will result in a $100 civil penalty.

An exit interview has been conducted with, and a copy of this report has been signed by and provided to Director, Tracy Martinez. Appeal Rights have been provided and explained to Director .
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Bardo BaluyotTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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