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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006098
Report Date: 08/06/2019
Date Signed: 08/06/2019 11:57:08 AM

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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RANCHO LOS AMIGOS CHILDREN'S CENTERFACILITY NUMBER:
198006098
ADMINISTRATOR:HELIA CASTELLONFACILITY TYPE:
850
ADDRESS:7755 GOLONDRINAS STREETTELEPHONE:
(562) 401-7981
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:59CENSUS: 24DATE:
08/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Center DirectorTIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPAs) Tiffanie Tran and Reiko Jones arrived at the above facility to conduct a Case Management Incident inspection to follow up on the self-reported incident that occurred at Rancho Los Amigos Children's Center on 03/27/19. The Monterey Park SW Regional Office received the incident report on 03/27/19. Upon arrival, LPAs met with Center Director and about 8:50 AM we toured the facility. LPAs observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

Based on the information that were gathered through interview, it revealed that, on the day of the incident there were 20 children with two teachers. During PM transition to go outside, staff observed child tripped on his own shoe and fell backwards bumped his head on the cubbies and sustained an open wound. Medical attention required. Parent was contacted. Child had two staples wound closure. Child returned school the next day with no restriction. At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was cited.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.

An exit interview was conducted, a copy of this report was provided to the noted person
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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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