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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 07/22/2025
Date Signed: 07/22/2025 04:54:33 PM

Document Has Been Signed on 07/22/2025 04:54 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:CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)FACILITY NUMBER:
191806528
ADMINISTRATOR/
DIRECTOR:		LAURA HERNANDEZFACILITY TYPE:
850
ADDRESS:4601 SUNSET BOULEVARDTELEPHONE:
(323) 361-4601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 89TOTAL ENROLLED CHILDREN: 59CENSUS: 48DATE:
07/22/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Laura Hernandez, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Saul Valenzuela conducted an unannounced Case Management inspection due to two incidents that were reported to the Department on 6/16/2025, and 7/11/2025. LPA met with Director Laura Hernandez who guided LPA on a tour of the facility. Census was taken.

On June 16th, 2025, an incident was self-reported to the Department via Email by the facility who reported that a child wandered away from the classroom and that staff found Child #1 near the lobby.



On July 11th, 2025, an incident was self-reported to the Department via Email by the facility who reported that a staff left children unsupervised during nap time.

All reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incidents reported to the Department.

During the inspection, LPA Valenzuela conducted interviews with six (6) staff, obtained copies of sign in/out sheets, and video footage of both incidents that occurred on 6/16/2025 and 7/11/2025.

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NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Saul Valenzuela
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/22/2025 04:54 PM - It Cannot Be Edited


Created By: Saul Valenzuela On 07/22/2025 at 03:37 PM
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: CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)
FACILITY NUMBER: 191806528

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/29/2025
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation.
This requirement is not met as evidence by:
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Director will conduct a staff meeting reviewing responsibility for providing care and supervision. Declarations from staff on what they learned will be submitted. Meeting minutes with signatures will be send to LPA by POC date.
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Based on interviews and video footage it was disclosed that staff were not responsible for providing care and supervision for children in care. This is an immediate risk for the health and safety of 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.
Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:
Saul Valenzuela
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/22/2025


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: CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)
FACILITY NUMBER: 191806528
VISIT DATE: 07/22/2025
NARRATIVE
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Regarding the incident on 6/16/2025, during interviews Staff #6 disclosed that they observed Child #1 (C1) near the lobby around 2:00 p.m. by themselves with no staff nearby. According to Staff #6 (S6) that they walked C1 back to their classroom and notified Staff #3 (S3) that the child was found outside of the classroom unsupervised. According to staff they are unsure how long the child was left unsupervised outside of the classroom, but staff stated that it was "less than a minute". According to S3 that they were changing another child's diaper when they heard the classroom door open and observed C1 walked out of the classroom door. Per S3 that they notified school leadership right away when child wandered outside of the classroom. Per Director, that each staff will review Title 22 Regulation for supervision to ensure that each child is not left unsupervised at all times.

LPA observed 6/16/2025 video footage that was obtained from the facility's security office. LPA observed three children near the entrance door of the classroom, while S3 was conducting diaper changes in the back of the classroom. LPA observed C1 exited out of the classroom as the two other children were following C1 when S3 observed the children, and the children returned back into the classroom with the exception of C1. Video footage obtained by the LPA does not have a time stamped, however LPA used a time stop watch and timed that C1 was out of the classroom was for approximately 55 seconds.

Regarding the incident on 7/11/2025, during interviews S3 disclosed that they were returning to the classroom when they observed Staff #7 (S7) laying on the floor with their eyes closed while children were napping. According to S3 that they tried calling S7 name and by the "fifth time" S3 told S7 that they needed to get up. S3 stated that S7 responded with a "sigh" when told to get up by S3. S3 stated that they left the classroom to write a report, that when they came back into the classroom they noticed that C2 was not in their cot, and S7 was laying on the floor with their eyes closed. According to S3 that they informed S7 that C2 was not in their cot and that S7 stood up and tried looking for C2 in the classroom.

Per S3 that they observed the sign in/out sheet and noticed that C2 parent signed the child out of the classroom while S7 was laying on the floor with their eyes closed. LPA observed the sign in/out sheet for 7/11/2025 and C2 was signed out by their parent at 2:07 p.m..------------- pg. 2 of 3 -------------------

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Saul Valenzuela
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
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: CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)
FACILITY NUMBER: 191806528
VISIT DATE: 07/22/2025
NARRATIVE
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S3 was unable to provide a time frame of long S7 was laying on the floor with their eyes closed to LPA. Staff #2 stated that they observed the video footage and that Staff #7 was on the floor with their eyes closed for a total of 26 minutes. Per Director, that they will implement new policy during nap time to ensure that teachers are alert and supervising children at all times.

LPA observed video footage of 7/11/2025 incident, in the footage S7 is observed sitting against the wall between two children. LPA was unable to determine if S7 had their eyes closed. During the 30 minute video duration, however LPA observed that S7 was unresponsive with their head tilted to the side for approximately 28 minutes. C2 parent walked in around the 23 minute mark of the video and grabbed C2 from their cot. 28 minutes into the 30 minute video, LPA observed S3 walk into the classroom after C2 was picked up by their parent, and S7 was observed to sit up and go back to sitting against the wall. LPA observed that S3 and S7 were unaware that C2 was signed out of the classroom during the video.

Based on the LPA’s observations, and interviews, the following deficiencies listed on the attached LIC 809D (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.



LPA Saul Valenzuela informed facility representative Laura Hernandez that this report dated 7/22/25 document(s) 1 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.Also, LPA Saul Valenzuela informed the licensee to provide a copy of this licensing report dated 7/22/2025 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.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Laura Hernandez.--------- pg. 3 of 3 -------------
NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Saul Valenzuela
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5