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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191226432
Report Date: 06/11/2024
Date Signed: 06/11/2024 11:51:31 AM

Document Has Been Signed on 06/11/2024 11:51 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:SUSANNA WESLEY CHILDREN'S CTR/INFANTFACILITY NUMBER:
191226432
ADMINISTRATOR/
DIRECTOR:		MARICELA HERNANDEZFACILITY TYPE:
830
ADDRESS:134 N. KENWOOD ST.TELEPHONE:
(818) 548-6229
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY: 19TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
06/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Renee Spivey, director TIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA), Anomeh Eivazian, conducted an unannounced case- management inspection to the above facility on 06/11/24 at 10:00 am. LPA met with Renee Spivey, director who guided LPA on a tour of the facility. During this inspection there were total of 5 infants present in the facility with two staff.

Based on LPA Eivazian observation on 05/14/24, LPA observed two infants were napping in nap room from 11:40 AM to 1:00 PM, while nap room door was closed, and one staff was not present in the nap room. Facility nap room is in Infant classroom, Baby Land, Red Family (0-12 months old) classroom. Facility nap room is half wall and half glass wall (transparency half wall) all the way to the ceilings. Per LPA’s observation, staff have visual supervision through half glass wall, but they do not have auditory supervision via half glass wall and while the nap room door was closed.



Per staff interviews on 05/14/24, while an infant is napping in nap room, they keep the nap room door closed while a staff member is not present in the nap room. However, staff have a buzzer to check on napping infants every 15 minutes.

Based on staff#6 interview on 05/14/24, due to street transformer malfunction and spark on 03/01/24, infant playground shade and some part of turf caught on fire and facility did not report this incident to the department. During this incident children and staff were not present on the infant playground.

LPA Eivazian informed director, Renee Spivey that this report dated 06/11/24 document(s) (1 Type A citation). Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432
VISIT DATE: 06/11/2024
NARRATIVE
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Also, LPA Eivazian informed the director, Renee Spivey to provide a copy of this licensing report dated (06/11/24) that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


The following deficiencies listed on the attached LIC 809 (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) 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, Renee Spivey.



REPORT END 2 OF 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/11/2024 11:51 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/11/2024 at 09:28 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/12/2024
Section Cited
CCR
101429(a)(1)

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 Responsibility for providing care and supervision for infants—
Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.
This requirement was not met as evidenced by…
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Per director, effective 06/10/24 a new schedule was made to ensure three staff are present in infant classroom all the time in order to have one staff in nap room when an infant is napping.
Per director, she will ensure one additional staff to be present in infant
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Based on staff interviews and LPA’s observation on 05/14/24, from 11:40 AM to 1:00PM, LPA observed two infants were napping in nap room, alone with nap room door closed. Staff did not have auditory supervision to napping infants.
This poses an immediate health, safety, and personal right risk to the children in care.
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classroom to have one staff in nap room when an infant is napping and meet the teacher child ratio requirements.

A written plan will be submitted to LPA by 06/12/24.

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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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/11/2024 11:51 AM - It Cannot Be Edited


Created By: Anomeh Eivazian On 06/11/2024 at 09:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SUSANNA WESLEY CHILDREN'S CTR/INFANT
FACILITY NUMBER: 191226432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
CCR
101212(d)

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department...
This requirement was not met as evidenced by...
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Per director, she will submit an unusual incident report regarding 03/01/24 fire to the department by 06/14/24 and a copy will be submitted to LPA Eivazian.
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Based on staff#6 interview on 05/14/24, due to street transformer malfunction and spark on 03/01/24, infant playground shade and some part of turf caught on fire and facility did not report this incident to the department.
This poses a potential health, safety and personal right risk to the children in care.
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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:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024


LIC809 (FAS) - (06/04)
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