191200283-6-1-2023-33-CC-AEIN-CSDPSU-20230601113456

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191200283
Report Date: 06/01/2023
Date Signed: 06/01/2023 11:35:05 AM

Document Has Been Signed on 06/01/2023 11:35 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	MONTROSE PRESCHOOL & INFANT CARE		FACILITY NUMBER:	191200283
ADMINISTRATOR:	TAYLOR, LINDA		FACILITY TYPE:	850
ADDRESS:	2700 MONTROSE AVENUE		TELEPHONE:	(818) 249-4048
CITY:	MONTROSE	STATE: CA	ZIP CODE:	91020
CAPACITY: 65	TOTAL ENROLLED CHILDREN: 55	CENSUS: 32	DATE:	06/01/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Erica Patterson, Director		TIME COMPLETED:	12:00 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 Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 06/01/23 at 8:20 AM due to an incident that occurred on Tuesday 05/09/23. LPA met with Erica Patterson, Director who guided analyst on a tour of the facility. During this inspection 32 preschoolers were present in the facility with 6 staff. Alleged Incident took place on 05/09/23. Incident was reported via telephone same working day. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received on Wednesday 05/10/23. The facility reported the incident within the required 24 hour time frame. LPA conducted interviews with four staff. Per staff#3 and staff#4 they do not have potential parent#1 conduct information. LPA obtained a copy of Staff#3 notes regarding this incident. Per staff #1, staff#2, and staff#3 on 05/09/23, while a potential parent was touring the facility, during transition from outside to inside the classroom and getting ready for lunch, staff#1 was changing diapers, staff #2 was on the carpet area and staff#5 was assisting child#1 to put on shoes. Per staff#1, staff#2, and staff#3 they did not observe staff#5 slap child#1, they heard child#1 had hard time to wear shoes and was kicking legs, staff#5 said to child#1: " You are being difficult". Per staff#2, staff#5 asked staff #2 to assist child#1 to wear shoes. Per staff#4, based on a phone conversation that staff#4 had with parent#1 on 05/09/23, parent#1 was not sure what exactly had happened and not sure if staff#5 hit child#1 or it was child#1 who was kicking legs not to wear shoes. REPORT CONTINUES ON NEXT PAGE 1 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

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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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: MONTROSE PRESCHOOL & INFANT CARE	FACILITY NUMBER: 191200283
	VISIT DATE: 06/01/2023

NARRATIVE

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LPA issued the Confidential Names List (LIC 811) to the director during this inspection. The Confidential Names List documents the staff and children involved with the incident documented in this report.

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when these incidents occurred. Therefore, there are no deficiencies being cited today, 06/01/23.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Erica Patterson at 12:00 p.m..

REPORT END 2 of 2

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023

LIC809 (FAS) - (06/04)

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