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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191599890
Report Date: 12/05/2024
Date Signed: 12/05/2024 01:43:40 PM

Document Has Been Signed on 12/05/2024 01:43 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:NELSON LAUPFACILITY NUMBER:
191599890
ADMINISTRATOR/
DIRECTOR:
M. GARAY, F. MARTINEZFACILITY TYPE:
850
ADDRESS:330 CALIFORNIA AVETELEPHONE:
(626) 933-8439
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 9DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Terri Torres & Ryan MartinezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On December 5, 2024, at 11:15 am Licensing Program Analysts (LPAs) Carolyn Tuba and Monica Ruiz conducted a case management inspection due to an incident that was self-reported by the facility. A Covid Risk assessment was conducted. LPAs met with Staff member, Terri Torres and Child Development Supervisor, Ryan Martinez arrived at the facility at 12:15 pm. to facilitate the visit. LPAs observed and took a census of 9 children with 2 staff members.

An Unusual Incident Report (UIR) was submitted by the facility on 12/2/2024 via email. The incident was reported to the facility by a parent and spoke to Manager, Monica Jarvis about a concern with her child and a staff member. This was reported to the Manager on 12/2/2024, however the parent disclosed that this incident occurred sometime approximately around 11/13/2024.

The incident was reported to the Department within the required 24 hours of occurrence.
During this investigation, LPAs conducted an interview with the Manager via telephone call. LPAs were unable to interview Child #1 (C1) due to C1 is attending another licensed facility. The Manager will be sending via email the documentation requested, such as injury reports, diaper logs and police department information. During this visit LPAs obtained the contact information for the staff and C1's parent. LPAs will be conducting further interviews with the parties involved.

No citations have been issued during today's visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Child Development Supervisor, Ryan Martinez.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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