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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019661
Report Date: 08/30/2019
Date Signed: 08/30/2019 01:49:39 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:DOVE DAY SCHOOLFACILITY NUMBER:
198019661
ADMINISTRATOR:JACQUELINE ALMEIDAFACILITY TYPE:
840
ADDRESS:908 W. ARROW HIGHWAYTELEPHONE:
(626) 919-1417
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:60CENSUS: 31DATE:
08/30/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Jackie Almeida, Head of SchoolTIME COMPLETED:
02:00 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 (LPAs) Rita Ramos and Alicia Mooberry conducted an unannounced case management inspection to the above facility. LPAs met with Jacqueline (Jackie) Almeida, Head of School, who guided analysts on a tour of the facility. There were 31 children with 6 staff present upon arrival.

During the visit LPAs were in Room 4 with Staff #1. LPAs and Staff #1 observed as Child #1 entered Room 4 and walked by LPAs and Staff #1 to use the restroom. LPAs asked Staff #1 where Child #1 was coming from since they entered Room 4 on their own. LPAs waited for Child #1 who informed and physically guided LPAs that they walked from the front of Room #6, to the back of Room 6, opened the door from Room 6 to enter Room 5, saw that the restroom door in Room 5 was closed, then walked passed Staff #2 in Room 5 and opened the door to Room 4 and entered Room 4 to use the restroom. Child #1 walked approximately 84 feet without a supervising teacher or staff (pictures were taken).

Per Child #1, they walked into Room 5 for the restroom but thought it was occupied so entered Room 4 because they heard adult voices (Staff #1 and LPAs) and thought it was okay since adults were present.

LPAs consulted with the Head of School in regards to supervision during the inspection.

The following deficiency listed on the attached deficiencies page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted 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 was conducted with Jacqueline Almeida, Head of School, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 SCHOOL
FACILITY NUMBER: 198019661
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/13/2019
Section Cited

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPAs observing that Child #1 walked from Room 6 through Room 5 and through Room 4 unsupervised. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Katherine HarewoodTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2