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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020436
Report Date: 08/17/2022
Date Signed: 08/17/2022 02:12:06 PM


Document Has Been Signed on 08/17/2022 02:12 PM - It Cannot Be Edited

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-VALLEY CHILDREN'S CENTERFACILITY NUMBER:
198020436
ADMINISTRATOR:VANESSA BURGUENOFACILITY TYPE:
850
ADDRESS:4400 N. ROXBURGHTELEPHONE:
(626) 472-6330
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:140CENSUS: 20DATE:
08/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:14 AM
MET WITH:Vanessa Burgueno, DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA) Thelma Razo conducted an unannounced Case Management – Incident inspection on this date, 8/17/2022. LPA met with Director Vanessa Burgueno. A COVID-19 risk assessment was made prior to entry to the facility. LPA stated the reason of the inspection is due to Unusual Incident which occurred on 8/10/2022 and was self-reported via phone by Director Burgueno to Community Care Licensing regarding personal rights concerns.

During today's inspection, interviews were conducted with 5 staff. LPA toured the facility to include the playground and 3 classrooms. There were 20 children and 6 staff at the facility. Staff-child ratio was met.

At this time, no deficiencies are being cited.

Exit interview was conducted with Director Vanessa Burgueno.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3387
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2022
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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