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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006099
Report Date: 06/21/2021
Date Signed: 06/21/2021 12:14:21 PM

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:
198006099
ADMINISTRATOR:HELIA CASTELLONFACILITY TYPE:
830
ADDRESS:7755 GOLONDRINAS STREETTELEPHONE:
(562) 401-7981
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:35CENSUS: 23DATE:
06/21/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Helia Castellon, DirectorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) T. Tran arrived at Rancho Los Amigos Children's Center to conduct a Case Management inspection that was self-reported on 04/21/2021. The Monterey Park South West Child Care Regional Office received the incident report on 4/30/2021.

About 9:20 AM, LPA toured the facility indoor and outdoor. Staff and children files review were conducted, and document were obtained. On the day of the incident, there were three staff supervised 12 children. Based on the information that were gathered during today's interviews, none of the center staff observed S2 grabbed C1's arm. C1 observed to show no sights of discomfort. No medical attention required. Parent was contacted. The facility had provided coaching to staff to prevent future incidents from reoccurrence.

At this time based on the available information it does not appear this incident was result of the Title 22 violation for personal rights. No deficiency was cited.

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

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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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