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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018562
Report Date: 03/01/2024
Date Signed: 05/14/2024 03:07:54 PM

Document Has Been Signed on 05/14/2024 03:07 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:COVINA DEVELOPMENT CENTERFACILITY NUMBER:
198018562
ADMINISTRATOR:SHEENA MINAYAFACILITY TYPE:
830
ADDRESS:437 W. SAN BERNARDINO RD. #111TELEPHONE:
(626) 967-7153
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 33TOTAL ENROLLED CHILDREN: 19CENSUS: 8DATE:
03/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Program Director Sheen MinayaTIME COMPLETED:
11:00 AM
NARRATIVE
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This is an amended report issued on 03/01/24 regarding an incident that occurred in the facility on 02/16/24. The incident was an accident and not a result of a violation of California Code of Regulations Title 22.
On 03/01/2024 at approximately 8:30am Licensing Program Analyst (LPA) Mary Silva conducted an unannounced case management inspection to ensure the facility was in compliance with Title 22 regulations. Licensing staff met with Program Manager Yesenia Arteaga and Program Director Sheena Minaya. The purpose of the inspection was explained. There was a total of 8 children present with 4 staff.

The department was made aware of an incident that occurred at the facility on 02/16/24 involving a child with serious injuries needing medical attention. Facility called the regional office on 02/16/24 to report the incident and submitted a written report on 02/20/2024.



During the inspection LPA conducted interviews with center staff. LPA obtained documentation in the form of facility roster, personnel report, sign in and sign out sheet for the month of February 2024, copy of incident report provided to parent, reviewed file for child #1, viewed video footage, angle of camera does not capture incident, photographs of the wrought iron gate and other documents pertaining to the incident. Based on the disclosures made during staff interviews, the incident occurred on 02/16/24 at approximately 11:00am in the infant playground. During the transition from the playground to the classroom child #1 caught tip of left ring finger in the hinges of the wrought iron gate, causing bottom tip of left finger under the nail to nearly be severed. Due to the extent of the injury child #1 was transported by ambulance to a hospital for medical attention. Per director immediately after the incident occurred the facility placed a wooden pilar to prevent the gate from opening more than 90 degrees and a sign to open the door inward in the interim of having the gate repaired.
__________________________Page 1_________________________________________
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562
VISIT DATE: 03/01/2024
NARRATIVE
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Based on the information verified during the inspection of the incident, no deficiencies are being cited in accordance with California Code of Regulations Title 22.

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. Appeal Rights were given.



Exit interview conducted and report was provided and reviewed with Program Director Sheena Minaya.
_______________________Page 2___________________________________________________
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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Document Has Been Signed on 03/01/2024 10:13 AM - It Cannot Be Edited


Created By: Mary Silva On 03/01/2024 at 09:27 AM
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: COVINA DEVELOPMENT CENTER
FACILITY NUMBER: 198018562

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/01/2024
Section Cited
CCR
101223(a)(2)

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Personal Rights 101223(a)(2)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. This requirement was not met as evidenced by...
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Director stated after the incident occurred on 02/16/24 facility placed a wooden pilar and a sign on the gate to only open door inward, therefore preventing similar incidents to occur. Repairs to the gate were made on 02/26/24. Per director child has returned to daycare on 02/26/24.
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Based on staff interviews at on 02/16/24 approximately 11:00am during the transition from the playground to the classroom. Child #1 caught left ring finger in the hinges of the wrought iron gate and was transported by ambulance to a hospital for emergency medical attention.
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On 02/26/24 facility provided photographs of the repairs made to the wrought iron gate. LPA observed the repairs made to the wrought iron gate, the hinges have an opening of 3 3/ 4 inches, preventing the bars from closing when door is opened or closed. The deficiency cited has been cleared on this date.

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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:Christina Gabelman
LICENSING EVALUATOR NAME:Mary Silva
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024


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