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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501775
Report Date: 02/13/2025
Date Signed: 02/13/2025 03:59:02 PM

Document Has Been Signed on 02/13/2025 03:59 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: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: 47DATE:
02/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Kristy KnightTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 2/13/2024, at 1:15 pm Licensing Program Analyst (LPA) Carolyn Tuba conducted a Case Management inspection due to an incident that was self-reported and submitted by the facility. The incident occurred on 1/28/2025 at approximately 4:10 pm. Covid risk assessment was conducted. LPA met with Director, Kristy Knight. LPA was given a tour and observed a census of 47 children with 7 staff during naptime.

The incident was reported to the Department within the required 24 hours of occurrence.

During this investigation, LPA conducted interviews with Director, Staff #1 (S1), and Staff #2 (S2) and took a photo of the play structure where the incident occurred. Child #1 (C1) was not interviewed due to age and non-verbal.

The Director stated that C1 was walking up the stairs of a play structure on the preschool playground and slipped causing him to fall on his right shoulder. Parents were informed and C1 was taken to urgent care for medical attention and resulted an injury. The Director stated that there was no sand on the steps as it had rained the day before and they had cleaned the steps of the play structure the same day of the incident. Director also stated the play structure was checked to see if there were any hazards and did not find any at the time. They will continue to make sure that no sand builds up. S1 and S2 confirmed of the incident that occurred but could not recall if there was sand or not during the play time. S2 stated they did not provide any 1st aid at the time of the incident. LPA advised the Director that in the future an ice pack would have been appropriate. An incident report was written to the parent and the Director will email a copy to the LPA; however, a copy of the medical report from urgent care was given during the visit. LPA researched the play structure and found it to be age appropriate (2 years to 5 years of age) which C1 falls in that age range.

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SUPERVISORS NAME: Katrina Chicote
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CLAREMONT UNITED CHURCH OF CHRIST ECC
FACILITY NUMBER: 191501775
VISIT DATE: 02/13/2025
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No citations have been issued at this time however the LPA did issue an advisory to make sure that the steps are free of sand each day before children’s play, due to the type of surface the steps are (smooth plastic) which could cause it to be a slipping hazard.

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: Katrina Chicote
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2025
LIC809 (FAS) - (06/04)
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