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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370796
Report Date: 04/20/2023
Date Signed: 04/20/2023 09:53:20 AM


Document Has Been Signed on 04/20/2023 09:53 AM - 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:LOS ALAMITOS CDCFACILITY NUMBER:
304370796
ADMINISTRATOR:DAGARIN, JEAN-MARIFACILITY TYPE:
850
ADDRESS:12582 KENSINGTON ROADTELEPHONE:
(562) 799-4585
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:24CENSUS: 8DATE:
04/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Carolyn Wertheim, DirectorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Mila Quinto conducted an unannounced case management incident inspection in response to a self-report Unusual Incident Report dated 4/6/2023. Upon arrival, LPA met with Lead Teacher, Sharyl Griffith. LPA observed 8 preschool children with 2 staff. At approximately 8:10am, the Director Carolyn Wertheim arrived at the facility.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 4/6/2023 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 4/5/23 a child eloped out of the playground and exited the school to look for Mom.

During today's inspection, LPA interviewed 3 staff members including the Director. LPA obtained a copy of the children’s roster via email. Due to insufficient information available at this time, the reported incident needs further investigation.

Exit interview was conducted. 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: Patricia MaganaTELEPHONE: (714) 743-5149
LICENSING EVALUATOR NAME: Mila QuintoTELEPHONE: (714) 293-6471
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023
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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