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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198001107
Report Date: 07/15/2021
Date Signed: 07/15/2021 12:19:25 PM

Document Has Been Signed on 07/15/2021 12:19 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:HAPPY CAMPERS LEARNING CENTERFACILITY NUMBER:
198001107
ADMINISTRATOR:LAU, JUDY C.FACILITY TYPE:
850
ADDRESS:14035 FRANCISQUITOTELEPHONE:
(626) 337-7254
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY: 84TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
07/15/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Yu- Ling, Assistant DirectorTIME COMPLETED:
12:30 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 07/15/21., at 12:15PM. Licensing Program Analyst (LPA) Fabiola Vasquez conducted a Case Management visit. LPA met with Assistant Director, Yu-Ling. The purpose of this report is to address concerns regarding Reporting Requirements.

On 05/18/21, during an interview with Assistant Director, she acknowledged an unusual incident occurred at the facility’s parking lot on 05/05/21 during hours of operation when there were children in care and was not reported to the Department. The Department does not have a record of a phone call to report the unusual incident that occurred on 05/05/21 or a written report from the Assistant Director. The unusual incident was not reported to CCLD as required. All unusual incidents must be reported timely to CCLD; with 24 hours by phone as well as in writing within 7 days. A blank copy of the Unusual Incident/Injury Report (LIC624) was provided and completed at the time of the visit.

The deficiencies listed on the following page are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D.

Deficiencies that are being cited need to be cleared to protect the health and safety of children in care.

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 Assistant Director, Appeal rights explained & provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2021
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
Document Has Been Signed on 07/15/2021 12:19 PM - It Cannot Be Edited


Created By: Fabiola Vasquez On 07/15/2021 at 11:23 AM
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: HAPPY CAMPERS LEARNING CENTER
FACILITY NUMBER: 198001107

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/22/2021
Section Cited
CCR
101212(d)(1)(C)

1
2
3
4
5
6
7
101212 Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified *** a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.**a written report** shall be submitted to the Department within seven days***
This evidence was not made by,

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director submitted a Unusual Incident/Injury report during today's visit, via email. 7/15/21 @ 11:51AM.
8
9
10
11
12
13
14
On 05/18/21, Assistant Diirector, acknowledged an unusual incident occurred at the facility’s parking lot on 05/05/21 during hours of operation and was not reported to the Department within the required 24 hours. The Administrator did not submit a written report within the required 7 days. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Claudia Guangorena
LICENSING EVALUATOR NAME:Fabiola Vasquez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2021


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