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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018620
Report Date: 12/05/2024
Date Signed: 12/06/2024 08:40:03 AM

Document Has Been Signed on 12/06/2024 08:40 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:AZUSA UNIFIED SCHOOL DISTRICT-LONGFELLOWFACILITY NUMBER:
198018620
ADMINISTRATOR/
DIRECTOR:		JENNY LEFACILITY TYPE:
850
ADDRESS:245 WEST TENTH STREETTELEPHONE:
(626) 815-4724
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY: 240TOTAL ENROLLED CHILDREN: 240CENSUS: 9DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Program Supervisor Georgianna TaylorTIME VISIT/
INSPECTION COMPLETED:
11:55 PM
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On 12/05/24 Licensing Program Analyst (LPA) Mary Silva conducted an unannounced case management inspection. Upon arrival LPA met with Principal Patricia Cubillo and Program Supervisor Georgianna Taylor, who guided LPA on a tour of classroom #9. The purpose of the inspection was explained. Census was taken. LPA observed 10 children and 3 staff. This is a full day preschool program Monday-Friday from 7:00am-6:00pm.

The purpose of this inspection is due to an incident that was reported on November 25, 2024. The facility reported this incident to the Department within the required 24 hours and submitted written unusual incident report on 12/02/24.

During the inspection LPA conducted interviews with 3 staff that were present during the incident. LPA reviewed file for child #1, obtained a copy of the district incident/accident report, Health Office Notification form given to parent and sign in and out sheet dated 11/01-11/22. LPA was led on a tour of the area where the incident occurred, and photographs were taken.

Based on the disclosures made during staff interviews, the incident occurred on 11/22/24 at approximately 8:45am as children were walking back from the cafeteria. Per staff #3, child #1 was walking in a line, twisted left ankle and fell to the ground. Staff #1 was walking in the middle of the line and staff #2 was at the front of the line. Due to the injury child #1 was taken to the office in a wheelchair. Parent was notified at 8:56am and authorized relative picked up child from facility at 9:18am. Per staff #2, facility contacted parent via parent square to follow up on the condition of child#1. Parent informed facility, child#1 was taken to the hospital where an evaluation was completed and determined child #1 fractured left foot.

Based on the information that was verified during the inspection and the information on the incident report, Licensing staff did not observe any type of deficiencies that warranted a citation at this time.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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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: AZUSA UNIFIED SCHOOL DISTRICT-LONGFELLOW
FACILITY NUMBER: 198018620
VISIT DATE: 12/05/2024
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The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting will result in a civil penalty of $100.00 dollars.

Exit interview conducted with program supervisor Georgianna Taylor, report and appeal rights were given.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Mary Silva
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC809 (FAS) - (06/04)
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