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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198013724
Report Date: 05/25/2022
Date Signed: 05/25/2022 11:16:34 AM

Document Has Been Signed on 05/25/2022 11:16 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:NUFFER ELEMENTARYFACILITY NUMBER:
198013724
ADMINISTRATOR:SHERRY HERRERAFACILITY TYPE:
850
ADDRESS:14821 JERSEY AVENUETELEPHONE:
5622104079
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 14DATE:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elizabeth Maldonado, Head TeacherTIME COMPLETED:
11:30 AM
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About 9:00 AM, Licensing Program Analyst (LPA) T. Tran made an unannounced Case Management Incident inspection to follow up on a self-reported incident that occurred at Nuffer Elementary on 03/28/22 regarding a child bumped the back of the head when picking up the toy from under the table and sustained a small scrape. The Monterey Park SW Regional Office received the writing incident report on 08/29/22. Upon arrival, LPA observed proper care and supervision.

LPA completed children files review. Staff files located at the main office, LPA will arrange another visit for files review. About 9:35AM, LPA conducted interviews with children, staff, and other. LPA obtained child's document and personnel report. Based on interviews conducted, it revealed that on the day of the accident there were three teachers with 19 children in care. Parent was contacted when the incident occurred. At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was found.

No deficiency was cited at this time. 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, Elizabeth Maldonado.

SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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