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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198017173
Report Date: 02/09/2022
Date Signed: 02/09/2022 03:20:02 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:NORWALK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198017173
ADMINISTRATOR:CAMPOY, KATYAFACILITY TYPE:
850
ADDRESS:14000 SAN ANTONIO DRIVETELEPHONE:
(760) 942-3433
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:20CENSUS: 10DATE:
02/09/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Site Supervisor Maria Brena TIME COMPLETED:
03:30 PM
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On 2/9/22 Licensing Program Analyst (LPA) Jeanette Estrada conducted a case management visit.
The purpose of this visit is to follow up on Covid 19 related incidents that were reported to CCL. Present were 10 children and 3 staff.

LPA reviewed Covid 19 Self Assessment with site supervisor during this visit.
LPA observed a sign in station at the entrance of the facility. Children are signed in before entering the facility and their temperature is taking by a teacher. Children and staff are wearing masks throughout the day. LPA observed sinks for hand washing in the classroom and in the outside play area. LPA observed staff cleaning and disinfecting the restroom after each use. LPA observed Staff disinfecting pens used for signing in/out.

There were no deficiencies cited during this visit. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and Appeal Rights and report were reviewed with the Site Supervisor Maria Brena.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3828
LICENSING EVALUATOR NAME: Jeanette EstradaTELEPHONE: (323) 229-6521
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022
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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