<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870577
Report Date: 02/02/2024
Date Signed: 02/02/2024 02:35:23 PM

Document Has Been Signed on 02/02/2024 02:35 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 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: 33DATE:
02/02/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Site supervisor, Lucy BryantTIME COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On February 2, 2024 at 10:15 am, Licensing Program Analysts (LPAs) Angelica Wallin and Alicia Mooberry conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on January 19,2024 in which a child, in the toddler room, slipped out of outdoor patio gate to the outdoor playground while staff was tending to another child. LPA met with site supervisor, Lucy Bryant, who provided information and assistance during the inspection. A census of 33 children was taken. LPAs observed 10 children with 5 staff in the toddler room.

During the course of the inspection, LPAs conducted interviews with one child and three staff. LPAs also reviewed the following documents: a January 19, 2024 unusual incident report, staff and children’s records, picture of removed play structure in classroom that prohibited use of accordion partition, ratio sheet on day of incident, and personnel sheet. LPAs evaluated folding scissor security gate located between outdoor patio and outdoor playground. LPAs completed measurements of folding scissor security gate and observed child was able to pass through space that is 11.5 inches wide and estimated 20 inches long. Per staff interviews, child stayed in playground area directly in front of folding scissor security gate within staff’s eyesight. LPAs observed outdoor playground is enclosed. Per interview with S1, during the incident, S4 present with 2 children in the outdoor patio while S1 was in classroom supervising 8 napping children. Per S1 interview, after child was retrieved additional staff came to provide assistance. During inspection, S4 and C2 were not present. LPAs were unable to conduct interviews with S4 and C2.

Based on the available information: observations, interviews with child and staff and record review, no Title 22 deficiencies cited. LPAs discussed with site supervisor, preventative measures regarding use of outdoor patio as space for non-napping children.



PG 1 OF 2
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 191870577
VISIT DATE: 02/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Per site supervisor, facility will no longer use outdoor patio as space for non-napping children and instead will utilize the accordion partition in classroom as divider to separate napping children and non-napping children. Director to submit written facility plan of action via email by Friday 2/9/24. LIC855 written declaration provided.

The content of this report was read and discussed in detail at the time of inspection with site supervisor, Lucy Bryant. An exit interview was conducted, a notice of site visit to be posted for 30 days and copy of appeal rights was provided.

PG 2 OF 2

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2