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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 06/18/2024
Date Signed: 06/18/2024 01:18:54 PM

Document Has Been Signed on 06/18/2024 01:18 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: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: 89CENSUS: 26DATE:
06/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Laura Hernandez, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
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On June 18, 2024, Licensing Program Analysts (LPAs) Monique Ayala and Priscilla Ochoa conducted an unannounced Case Management Inspection – Plan of Correction at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with director, Laura Hernandez who guided LPAs on a tour of the facility. LPAs observed 26 children in care. The purpose of this inspection is to ensure that the facility is in compliance with Title 22 Regulations and the deficiencies cited on 06/18/2024 were corrected.

Licensing staff observed and reviewed the following:

· Director was to hold a staff meeting reviewing personal rights for children in care. LPA obtained a copy of sign in sheet for staff that attended the meeting



Letters of Deficiencies Citations Cleared were provided for deficiencies corrected.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00

An exit interview was conducted, and a copy of this report was provided to director, Laura Hernandez.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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