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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890433
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:06:20 PM

Document Has Been Signed on 11/03/2023 04:06 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:MERIDIAN EARLY EDUCATION CENTERFACILITY NUMBER:
191890433
ADMINISTRATOR:VIVIANA LEDEZMAFACILITY TYPE:
850
ADDRESS:6124 RUBY PLACETELEPHONE:
(323) 254-6749
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY: 114TOTAL ENROLLED CHILDREN: 114CENSUS: 46DATE:
11/03/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Principal David ZendejasTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management- Incident inspection at the above facility on 11/03/23 at 02:55 p.m. LPA met with Principal David Zendejas who guided LPA on a tour of the facility. Census was taken.

The purpose of this inspection is to follow up on an unusual incident report that occurred on 06/02/23 and was reported to the Department by the facility on 06/09/23, parent alleges that Child 1 (C1) sustained a fracture while in care.

During the investigation on 08/15/23, LPA interviewed Staff 1 (S1-2), Child 2 (C2), obtained a copy of facility roster, and a copy of the sign in sheet for the week of 06/05-06/09. C1 was not present at the facility during this visit due to C1 transitioning to kindergarten.

LPA interviewed Parent #1 (P1) of C1 on 10/18/23. According to P1, C1’s arm looked off during pick up time on 06/02/23. P1 stated that the facility is pretty good at notifying P1 of any injuries or incidents, however, no one said anything on that day. Per P1, thought nothing of it. On 06/03/23, C1 was taken to urgent care due to pain when moving the arm, a certain way. C1 stated that it hurts. According to P1, C1 had a lump (not visible) and cherry cuts around and on the elbow. P1 also stated that on 06/02/23, C1 was crying in the playground area and S1 asked what was wrong; C1 stated he was tired. C1 did not disclose falling or having pain to any staff. According to S1, they were not aware that anything had happened to C1 until P1 reported the fracture on 06/09/23. Per S1, does not recall seeing C1 fall or complain of any pain. S2 stated that C1 never mentioned being injured and does not recall seeing C1 fall. Per P1, C1 returned to the facility on 06/05/23 and a Dr’s note was provided. LPA conducted a file review for C1 during inspection on 08/15/23 and did not observe a copy of the Dr's letter for 06/05/23; however, a note of a Dr's visit for 06/30/23 was observed. The Dr’s note restricted C1 of any P.E. P1 did not notify the facility of C1’s fracture on 06/05/23, it was until 06/09/23 that the facility was notified. P1 does not know why they waited until 06/09/23 to report the injury to the facility.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2023
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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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: MERIDIAN EARLY EDUCATION CENTER
FACILITY NUMBER: 191890433
VISIT DATE: 11/03/2023
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P1 sent LPA pictures of C1’s arm and elbow. LPA observed what appeared to be scrapes on the arm and near the elbow. LPA observed C1 had a minimal swelling. P1 also provided the urgent care summary of visit which diagnosed C1 of suffering a “closed fracture.”

At this time, there were no deficiencies cited during today’s inspection.

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, a civil penalty of $100 can be assessed.

Exit interview was conducted, and appeal rights were given, along with a copy of this report was provided to the Principal David Zendejas.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023
LIC809 (FAS) - (06/04)
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