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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200283
Report Date: 09/13/2024
Date Signed: 09/13/2024 01:32:23 PM


Document Has Been Signed on 09/13/2024 01:32 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:MONTROSE PRESCHOOL & INFANT CAREFACILITY NUMBER:
191200283
ADMINISTRATOR:ERICA PATTERSONFACILITY TYPE:
850
ADDRESS:2700 MONTROSE AVENUETELEPHONE:
(818) 249-4048
CITY:MONTROSESTATE: CAZIP CODE:
91020
CAPACITY:65CENSUS: 26DATE:
09/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Lisa Castaneda TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management Inspection to the above facility . Upon arrival LPA met with the Facility Representative, Lisa Castaneda , who guided LPA on a tour of the facility . During the visit LPA observed 26 children with 8 staff members .

During the visit , LPA obtained information regarding incident that happened on 08/19/24 on the facility grounds . Based on the information obtained , Child #1 had an allergic reaction while in care and medical help was required .
Per section 101212 Reporting Requirements , licensee shall notify the Department upon the occurrence , during operation of the childcare center of any events specified in section (d) (1) below, and reports shall be made to the Department by telephone or fax within the Department`s next working day and during its normal hours . In addition, a written report containing the information specified shall be submitted to the Department within seven days following the occurrence of such event .

Based on the information obtained the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of
$100.00
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
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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Document Has Been Signed on 09/13/2024 01:32 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: MONTROSE PRESCHOOL & INFANT CARE
FACILITY NUMBER: 191200283

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2024
Section Cited
CCR
101212(d)(1)(C)

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101212Reporting Requirements d)Upon...occurrence.. any... events specified..below, report shall be made ... by telephone...fax within the.. next working day and during... business hours...(1)Events reported..(C)Any unusual incident..This requirement is not met evidenced by
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Director will review Reporting requirements and will send a declaration to LPA by POC date .
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Based on the information obtained child #1 had allergic reaction on the facilty grounds. Staff called 911 and Epi pen was provided .
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Shushanik SafaryanTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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