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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012912
Report Date: 05/05/2025
Date Signed: 05/05/2025 11:55:00 AM

Document Has Been Signed on 05/05/2025 11:55 AM - 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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LIVING WAY DAY CARE CENTERFACILITY NUMBER:
198012912
ADMINISTRATOR/
DIRECTOR:		RFACILITY TYPE:
830
ADDRESS:835 HASTINGS RANCH DR.TELEPHONE:
(626) 351-6253
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 12DATE:
05/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Director Darlene SimoneTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Stephanie Li conducted an unannounced Case Management inspection due to an incident that occurred on 4/1/2025 and was reported to the Department on 4/9/25. A risk assessment was conducted. LPA met with Director Darlene Simone, to whom the reason for the visit was explained. Director guided LPA on a tour of the facility. There were 12 children present and 2 staff. The facility was observed to be operating within the license capacity limitations.

On 4/9/2025, an unusual incident report was made to the Department regarding an incident that occurred during outdoor playtime. A toddler child was playing in the lower playground (cement yard) with a fire truck. The teacher had redirected the toddler to not ride on the toy fire truck, then turned away to assist another child. Another child came to tell the teacher that the toddler had fallen and couldn’t get up. The toddler didn’t seem to be able to walk and was afraid to put pressure on it. The incident appeared to happen while attempting to ride the small fire truck. The car slipped out from underneath him and his right leg was folded under and the left leg was straight out in front of him. First aid care was applied and mother was immediately contacted. Child was monitored and mother picked up within minutes.

During todays visit, LPA interviewed Director regarding the incident, observed the fire truck and lower playground, visited toddler classroom and observed children in music and movement. Child has returned to school as of today. Mother is a nurse and didn’t take him to the ER until the next day and discovered that he had a fractured femur. Child had to wear a splint for 4 weeks and mother kept him home during that time. Facility provided supporting documents: photos, email notification from mother, and teacher notes along with incident report on 4/9/25. *continued on next page.......
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/05/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LIVING WAY DAY CARE CENTER
FACILITY NUMBER: 198012912
VISIT DATE: 05/05/2025
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Incident occurred on 4/1/25. Facility reported incident on 4/9/25. Per director, she didn't receive notification of the child's broken femur until April 3rd and thought that she had 7 days to submit the report. LPA advised that incidents shall be reported within 24 hours of occurrence and written reports shall be submitted within 7 days of the occurrence. Reference of Title 22 regulation and code included below:

101212 (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, 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. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.

LPA printed Title 22 section 101212 Reporting Requirements and provided to Darlene Simone for reference. LPA reminded director that failure to report timely may result in citations being issued.

Based on information obtained during this visit, no follow up is necessary regarding the incident reported. No deficiencies are being cited at this time.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Director Darlene Simone.

NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Stephanie Li
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2025
LIC809 (FAS) - (06/04)
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