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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198009710
Report Date: 02/08/2023
Date Signed: 02/08/2023 04:32:03 PM

Document Has Been Signed on 02/08/2023 04:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:UNIVERSITY GARDENS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198009710
ADMINISTRATOR:JOANNA WILLIAMSFACILITY TYPE:
850
ADDRESS:1250 W. JEFFERSON BLVD.TELEPHONE:
(323) 733-1650
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
02/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Jazmin Munoz Peralta, Site SupervisorTIME COMPLETED:
03:50 PM
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On Wednesday, February 8, 2023 at 2:54 p.m., Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management inspection at the above facility to follow up on the self reported incident that occurred on 1/20/23 in child sustaining an injury. LPA met with Jazmin Munoz Peralta, Site Supervisor who guided the LPA on a tour of the facility. No children present during this visit. Also, phones and internet were down at the facility.

LPA Rviera interviewed staff, reviewed documentation, and obtained copies of relevant documents. determining whether or not a violation occurred.

Base on the information provided and documents received in regards the incident that occurred on 1/20/23, the facility followed procedures to ensure child was in a safe environment, received first aid, notifying the parents and made recommendation to take the child to the doctor for further evaluation. Therefore, LPA Rivera determined there to be no violation of Tittle 22.

Upon receipt, Notice of Site Visit shall be posted for thirty (30) consecutive days where the parent/guardian of children enter and exit the facility Failure to maintain posting as required will result in a $100 civil penalty.

Exit interview conducted with Site Supervisor Jazmin Munoz Peralta and appeal rights were provided and explained.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2023
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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