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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018852
Report Date: 12/03/2024
Date Signed: 12/03/2024 11:02:47 AM

Document Has Been Signed on 12/03/2024 11:02 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:PROTOTYPES CHILD DEV. CTR.FACILITY NUMBER:
198018852
ADMINISTRATOR/
DIRECTOR:		KYM ALLENFACILITY TYPE:
830
ADDRESS:845 E. ARROW HIGHWAYTELEPHONE:
(909) 397-4694
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 32TOTAL ENROLLED CHILDREN: 24CENSUS: 5DATE:
12/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Lead Teacher Wendy AguirreTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analysts (LPA)s Stephanie Li and Kamile Martin conducted an unannounced Case Management inspection due to an incident that occurred on 11/6/24 and was reported to the Department on 11/7/24. A COVID risk assessment was conducted. LPA met with Lead Teacher Wendy Aguirre to whom the reason for the visit was explained. Teacher guided LPA on a tour of the classroom. There are currently 24 children enrolled. Infant classroom is E1 and toddler classrooms are E2 and B1. There were 5 children present and 3 staff. Facility is open from 7:30am-3:30pm. The facility was observed to be operating within the license capacity limitations.

On 11/7/2024, an unusual incident report was made to the Department regarding an injury that occurred. A walking infant fell while walking and bumped his head on the middle shelf. Child sustained a gash on his forehead above his right eyebrow about a half an inch long. Mom and district nurse were notified. Nurse recommended stitches. Mom picked up child and took him to urgent care.

During todays visit, LPA's interviewed both lead teachers, observed the furniture and shelving, and verified child's treatment care. Child's wound was sealed with medical glue and he missed one day of school per mothers decision. LPA's observed that furniture and shelving edges are properly rounded. Per teacher, the child landed onto and hit the middle shelving edge. LPA's observed that the middle shelf is not rounded. Photos of furniture were captured. LPA's observed that the middle shelf is where the infants fall zone is. Teachers noted that child had begun walking the same week injury occurred and noted that he is walking better now. LPA's advised that if similar injuries continue on the middle shelf that facility can put shelf bumpers to offer padding to soften the impact. LPA's discussed with teachers best practices for children beginning to walk, recommended to not wear shoes that would hinder walking. Teachers shared that they have been having an ongoing conversation regarding their shoes.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PROTOTYPES CHILD DEV. CTR.
FACILITY NUMBER: 198018852
VISIT DATE: 12/03/2024
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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. No deficiencies are being cited at this time.

A 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.

Exit interview conducted and report was reviewed with Lead Teacher Wendy Aguirre.

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SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Stephanie Li
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC809 (FAS) - (06/04)
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