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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501798
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:46:53 PM

Document Has Been Signed on 04/18/2024 04:46 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:ABILITY FIRSTFACILITY NUMBER:
191501798
ADMINISTRATOR/
DIRECTOR:		JULIE MARTINFACILITY TYPE:
840
ADDRESS:480 SOUTH INDIAN HILL BLVD.TELEPHONE:
(909) 621-4727
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 16DATE:
04/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Bonita RamosTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On April 18, 2024, at 3:00 pm Licensing Program Analyst (LPA) Carolyn Tuba conducted a case management to amend report and assess civil penalties. LPA met with Program Supervisor, Bonita Ramos who guided LPA to obtain the census of 16 children/participants with 7 staff.

During a previous inspection on 2/13/2024 an LIC 809 (deficiency page) was issued in accordance and identified with as California Code of Regulations Title 22, 101229(a)(1). During today’s visit civil penalties of an immediate $500 are being assessed on an LIC 421IM for Absence of Supervision due to a child wandering away from the facility on 1/23/2024. On this visit LPA amended the LIC-809D page from a previous visit conducted on 2/13/2024 due to missing language.

LPA informed facility administrator that an informal office meeting will be scheduled with the department, at a future date and time and will be held at the Regional Office.

Notice of site visit was given to the licensee and must remain posted for 30 days. Exit interview conducted and report was reviewed with Program Supervisor, Bonita Ramos.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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