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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
300600390
Report Date:
10/22/2021
Date Signed:
10/22/2021 02:53:02 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
GOOD SHEPHERD PRE SCHOOL
FACILITY NUMBER:
300600390
ADMINISTRATOR:
ALVAREZ-MACKOW, BERNADETTE
FACILITY TYPE:
850
ADDRESS:
7082 CRESCENT AVENUE
TELEPHONE:
(714) 827-6440
CITY:
BUENA PARK
STATE:
CA
ZIP CODE:
90620
CAPACITY:
74
CENSUS:
26
DATE:
10/22/2021
TYPE OF VISIT:
POC
UNANNOUNCED
TIME BEGAN:
03:00 PM
MET WITH:
Bernadette Alvarez-Mackow, Director
TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) P Rivas conducted an unannounced plan of correction visit to clear deficiency cited on 10/12/21 under
Health and Safety Code (H&SC) Section 1596.8662(4)(b)(1)
Mandated Reporter Training.
An extension on the plan of correction date was given through 10/25/21.
During today's visit Director provided LPA copies of Current Mandated Reporter Training Certificates for
four teachers and for Director. Director's certificate expires 10/15/2023. Staff #1 expires 12/05/21; Staff#2 expires 10/19/2023; staff#3 expires 10/20/2023; Staff #4 expires 10/21/2023.
Deficiency has been cleared.
An exit Interview was conducted. Report was reviewed and discussed. The director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.
SUPERVISOR'S NAME:
Rina Lopez
TELEPHONE:
(714) 703-2808
LICENSING EVALUATOR NAME:
Pat Rivas
TELEPHONE:
714-703-2800
LICENSING EVALUATOR SIGNATURE:
DATE:
10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/22/2021
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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