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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014168
Report Date: 11/15/2024
Date Signed: 11/15/2024 10:36:34 AM

Document Has Been Signed on 11/15/2024 10:36 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:KIDS KLUB SAN GABRIEL / ROSEMEADFACILITY NUMBER:
198014168
ADMINISTRATOR/
DIRECTOR:
JILL LODATOFACILITY TYPE:
850
ADDRESS:4930 EARLE AVENUETELEPHONE:
(626) 288-4400
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY: 149TOTAL ENROLLED CHILDREN: 166CENSUS: 110DATE:
11/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Jill Lodato, DirectorTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Saul Valenzuela conducted an unannounced Case Management Incident inspection to follow up on an incident that was reported to the Department on 10/7/2024. LPA met with Director Jill Lodato who guided LPA on a tour of the facility. Census was taken.

On October 7, 2024, an incident was self reported to the Department via Email by the facility who reported that child tripped hitting their right side of their head on the apparatus stairs.



Report was reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incident reported to the Department.

During the inspection, LPA Valenzuela conducted interviews with staff. Regarding incident that occurred on 10/4/2024, incident was observed and first aid was applied. Child was taken to the doctor- per doctors note it stated that child was able to return to school on 10/7/2024, no restrictions returning to school. Per Director, child no longer attends the school. LPA obtained copies of injury report, and doctor's note.

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

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with facility representative, Jill Lodato

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Brandi VanOostenTELEPHONE: (323) 854-8930
Saul ValenzuelaTELEPHONE: 323-981-3350
DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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