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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870577
Report Date: 08/11/2023
Date Signed: 08/11/2023 11:27:27 AM

Document Has Been Signed on 08/11/2023 11:27 AM - 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 S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:WILLOWBROOK CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191870577
ADMINISTRATOR:SONIA LOVEFACILITY TYPE:
850
ADDRESS:12829 SO. JARVIS AVE.TELEPHONE:
(310) 352-4486
CITY:LOS ANGELESSTATE: CAZIP CODE:
90061
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 30DATE:
08/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Lucy BryantTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Angelica Wallin and Warren Birks conducted a Case Management Incident inspection. This inspection is regarding a personal rights incident that took place on June 16, 2023. LPA met with Site Supervisor Lucy Bryant who provided information and assistance during the inspection.

During the course of the inspection, LPAs conducted interviews with five children and three staff. LPAs also reviewed the following documents: a June 20, 2023 unusual incident report, employee HR reports, and employee written declaration statement. During conducted interviews, LPAs received no corroborated disclosures of incident. Child #6 is unavailable for interview at this time. LPAs may make an additional visit to interview child #6 at a later date.

Staff reported the incident on 6/22/2023 via telephone call and emailed written report. The Information provided matches the incident report. At this time, there are no deficiencies cited.

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. Exit interview was conducted with Site Supervisor Lucy Bryant.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/11/2023
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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