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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012158
Report Date: 04/08/2024
Date Signed: 04/08/2024 04:29:10 PM

Document Has Been Signed on 04/08/2024 04:29 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S ACADEMY OF SUCCESSFACILITY NUMBER:
198012158
ADMINISTRATOR/
DIRECTOR:		SINTTIA BECERRAFACILITY TYPE:
850
ADDRESS:10839 LA REINA AVENUETELEPHONE:
5622314373
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 20DATE:
04/08/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:20 PM
MET WITH:Kelly EcheverriaTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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While conducting an investigation for a complaint, Licensing Program Analyst (LPA), T. Tran observed the following deficiency:

During today's visit, while touring the facility, LPA observed children were napping without a sheet to cover the cot or mat. Center director has addressed this violation with the center staff during today's visit. Plan of cleared as of today.

Facility was cited for Type B deficiency. See Facility Evaluation Report LIC 809D for deficiency cited.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the facility representative, Kelly Echeverria.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2024
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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Document Has Been Signed on 04/08/2024 04:29 PM - It Cannot Be Edited


Created By: Tiffanie Tran On 04/08/2024 at 02:17 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDREN'S ACADEMY OF SUCCESS
FACILITY NUMBER: 198012158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2024
Section Cited
CCR
101239.1(c)

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This requirement is not met as evidenced by
based on the observation facility had children napping without a sheet to cover the cot or mat which poses a potential health and safety risk to children in care.
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Center Director agrees to review the napping requirement with the staff today then collect all attendee's signature. LPA obtained the document during today's viist.

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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:Denise Gibbs
LICENSING EVALUATOR NAME:Tiffanie Tran
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024


LIC809 (FAS) - (06/04)
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