<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018562
Report Date: 08/30/2019
Date Signed: 08/30/2019 05:53:28 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:COVINA DEVELOPMENT CENTERFACILITY NUMBER:
198018562
ADMINISTRATOR:JEPPSON, PAULAFACILITY TYPE:
830
ADDRESS:437 W. SAN BERNARDINO RD. #111TELEPHONE:
(626) 967-7153
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:33CENSUS: 16DATE:
08/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:51 PM
MET WITH:Sheena Yrma MinayaTIME COMPLETED:
05:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Cynthia Reyes arrived at the facility to conduct an inspection to the Infant component and observed deficiencies to this component while at the facility. LPA was not able to site on this date due to insufficient time and the school was closing. LPA did discuss with Program manager that an additional inspection will be conducted and citation will be done on the next inspection.

LPA informed director of the citations the LPA had observed on todays date regarding reporting requirements, commingling, no staff in the napping room while an infant sleeping, infants walking threw the preschool play ground, no staff personnel report and no children roster available to review.

Exit interview conducted and a copy of this report, appeal rights and the notice of site visit was left with Sheena Yrma Minaya.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1