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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501775
Report Date: 07/31/2024
Date Signed: 07/31/2024 04:13:29 PM

Document Has Been Signed on 07/31/2024 04:13 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CLAREMONT UNITED CHURCH OF CHRIST ECCFACILITY NUMBER:
191501775
ADMINISTRATOR/
DIRECTOR:		KNIGHT, KRISTYFACILITY TYPE:
850
ADDRESS:233 W HARRISON AVETELEPHONE:
(909) 624-2916
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 45DATE:
07/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Kristy KnightTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On July 31, 2024, at 1:45 pm Licensing Program Analysts (LPAs) Carolyn Tuba and Priscilla Ochoa conducted a case management inspection due to an incident that was self reported and submitted by the facility that occurred on 5/24/2024. Covid risk assessment was conducted. LPAs met with Director, Kristy Knight. Director guided LPAs on a tour of the facility and obtained a census of 45 children with 10 staff.

The incident was reported to the Department within the required 24 hours of occurrence. The incident was due to an injury that occurred on the playground with a child and required medical attention.

During this investigation, LPAs conducted interviews with the Director, Staff #1 (S1), #2 (S2) and #3 (S3). Child #1 (C1) was too young to interview. LPAs obtained the parent incident report, and the medical discharge paperwork. LPAs obtained photographs of where the incident occurred.

No citations have been issued at this time.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director, Kristy Knight.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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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