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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014039
Report Date: 11/26/2024
Date Signed: 11/26/2024 10:34:23 AM

Document Has Been Signed on 11/26/2024 10:34 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:ASSISTANCE LEAGUE OF LOS ANGELESFACILITY NUMBER:
198014039
ADMINISTRATOR/
DIRECTOR:		YOLANDA QUINTEROFACILITY TYPE:
850
ADDRESS:5436 HOLLYWOOD BOULEVARDTELEPHONE:
(323) 465-5281
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 60TOTAL ENROLLED CHILDREN: 47CENSUS: 32DATE:
11/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kathy Tenorio, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) Saul Valenzuela conducted an unannounced Case Management inspection due to an incident that was reported to the Department on 11/19/2024. LPA met with Director Kathy Tenorio who guided LPA on a tour of the facility. Census was taken.

On November 15th, 2024, one incident was self-reported to the Department via Phone by the facility who reported a child sustained an injury that required medical treatment.



All reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incidents reported to the Department.

During the inspection, LPA Valenzuela conducted interviews with staff. Regarding the incident on 11/15/2024, Staff #2 observed Child #1 running around the outdoor apparatus when they saw Child #1 fall and land on their right arm. Per Director, first aid was administered, and parent disclosed taking child # 1 to the emergency room- where it was determined that child had a fracture right arm and right arm was placed in a cast. Child #1 has not been cleared to return to school, and clearance is pending at follow up appointment.

LPA asked for copies of ouch report, chronological notes from director, and hospital discharge forms.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/26/2024
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
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: ASSISTANCE LEAGUE OF LOS ANGELES
FACILITY NUMBER: 198014039
VISIT DATE: 11/26/2024
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A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Kathy Tenorio.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Saul Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC809 (FAS) - (06/04)
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