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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013102
Report Date: 08/20/2024
Date Signed: 08/20/2024 01:41:03 PM

Document Has Been Signed on 08/20/2024 01:41 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:NEW LIBERTY CHILD DEVELOPMENT CENTER/DREWFACILITY NUMBER:
198013102
ADMINISTRATOR/
DIRECTOR:		MATTHEW KENNEDYFACILITY TYPE:
850
ADDRESS:5328 CENTRAL AVENUETELEPHONE:
(323) 234-3167
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 82TOTAL ENROLLED CHILDREN: 82CENSUS: 38DATE:
08/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Director of Education - Edwina ShiversTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) R. Derraco conducted an unannounced case management vist to the above mentioned facility on 08/20/24. LPA began this inspection at 12:30PM and was met by Director of Education, Edwina Shivers, who guided analyst on a tour of the facility. LPA observed 38 children in care and 9 adults caring for the children. The facility's phsycial plant was observed to be in compliance with California Code of Regulation (CCR) Title 22 regulations.

The purpose of this visit is to issue citation based on staff interviews conducted. Individuals interviewed state that they are unaware of Community Care Licensing Divisions procedure on reporting unusual incidents. LPA observed ouch reports given to parents of children that have had incidents occur while in care. Individuals interviewed state that when children have an incident, staff do not follow up with parents on the status of the child. Per FAS review, last Unusual Incident reported to the Department occurred in 08/2022. Individuals interviewed state that they would receive an ouch report when incidents occur however no follow inquiry is made to check on the status of the child. LPA advised Director that a Type B citation under California Code of Regulation (CCR) Section 101212(d)(1)(C) will be issued.

Notice of site visit was issued and must remain posted for 30 days

Exit interview conducted and report reviewed with Director Edwina Shivers.
SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Randy Derraco
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/20/2024 01:41 PM - It Cannot Be Edited


Created By: Randy Derraco On 08/20/2024 at 01:06 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: NEW LIBERTY CHILD DEVELOPMENT CENTER/DREW
FACILITY NUMBER: 198013102

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2024
Section Cited
CCR
101212(d)(1)(C)

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101212 Reporting Requirements(d)... during the operation of a child care center, a report shall be made to the Dept. by telephone or fax within the Dept's next working day...(1)(C) Any unusual incident...that threatens the...health or safety of any child. This requirement is not met as evidenced by:
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Informal meeting to be scheduled with LPA nd LPM. Director states will forward training agenda and plan from Quality Assurance department to retrain staff and notfiy parents
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Based on observation and interviews, the Director did not report to the department and unusual incident that threatened the health or safety of a child which poses a potential health, safety and personal rights risk to persons in care
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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:Randy Derraco
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2024


LIC809 (FAS) - (06/04)
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