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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370520
Report Date: 11/05/2020
Date Signed: 11/05/2020 02:42:17 PM

Document Has Been Signed on 11/05/2020 02:42 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LEARNING SPOT CHILD DEVELOPMENT CENTER, THEFACILITY NUMBER:
304370520
ADMINISTRATOR:MARIA HERNANDEZFACILITY TYPE:
850
ADDRESS:12388 GARDEN GROVE BLVD.TELEPHONE:
(714) 534-0467
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY: 66TOTAL ENROLLED CHILDREN: 0CENSUS: 34DATE:
11/05/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria Hernandez- DirectorTIME COMPLETED:
12:00 PM
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Tele- Inspection Case Management Visit due to COVID-19 State of Emergency

Licensing Program Analyst (LPA) Jordann Nelson conducted a case management visit on 11/05/2020 due to an Unusual Incident Report (UIR) received in the Regional Office on 10/16/2020 by Director Maria Hernandez. The UIR stated that Director Maria received an email stating that a child in care suffered a sever injury to their right hand.

LPA Nelson notified the Director that due to COVID-19 and Department of Public Health (DPH) guidelines of social distancing a Tele-Inspection would be conducted. A FaceTime call was made with Director Maria Hernandez. LPA verified the facility was providing care for children of essential workers. During the Tele-Inspection there were 34 children present, 18 school age children, and 16 preschool children present in care with 7 staff providing care.

A review of the Facility Personnel Report Summary on 11/05/2020 indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

Continued on LIC 809 Pg 2

Patricia Magana
Jordann Nelson
DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: LEARNING SPOT CHILD DEVELOPMENT CENTER, THE
FACILITY NUMBER: 304370520
VISIT DATE: 11/05/2020
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During the Tele-Inspection LPA Nelson interviewed Director Maria Hernandez. Information was requested regarding medical records from this incident. A tour of the Facility was also conducted during the Tele-Inspection. Unusual Incident Report stated facility began their own investigation and understood the severity of the incident which Director Maria confirmed. A copy of the Children’s Roster was requested, and additional interviews will be conducted regarding the incident. Due to insufficient information available at this time, the above incident needs further review.

Exit interview was conducted, Report was read, and Appeal Rights were explained to Director Maria Hernandez via Tele-Inspection. A copy of the report along with Appeal Rights will be email to Director with a Read Receipt requested to acknowledge report was received. Director was asked to respond to email by copying and pasting “I have read and received the Report and Appeal Rights, I acknowledge receipt.” Report LIC 809 will also be mailed if those options are not available.

SUPERVISOR'S NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020
LIC809 (FAS) - (06/04)
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