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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020089
Report Date: 10/19/2021
Date Signed: 10/19/2021 03:18:24 PM

Document Has Been Signed on 10/19/2021 03:18 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LEARNING TREE MONTESSORI OF ARCADIAFACILITY NUMBER:
198020089
ADMINISTRATOR:CAROLYN MORALESFACILITY TYPE:
850
ADDRESS:9845 E LEMON AVETELEPHONE:
(626) 241-1234
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 120TOTAL ENROLLED CHILDREN: 98CENSUS: 86DATE:
10/19/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Victoria Garcia, DirectorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Case Management inspection due to an incident that was reported to the Department on October 12, 2021. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Director, Victoria Garcia who guided LPA on a tour of the facility. Census was taken.

On October 12, 2021 an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff and the parent of child in question, LPA Garcia determined that during outdoor play child fell and hit the mouth area on the apparatus steps. Although staff was present and observed the incident, staff could not reach the child in time to prevent fall. At 10:13 a.m., during this inspection LPA did not observe any tripping hazards near or on the area where incident took place. Child was taken to the doctor and received stiches. Child has returned to day care.



REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2021
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LEARNING TREE MONTESSORI OF ARCADIA
FACILITY NUMBER: 198020089
VISIT DATE: 10/19/2021
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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. The facility followed all proper procedures; Staff administered first aid, child’s parent was notified, incident report was sent in properly and timely and all medical needs were met. Per Director, staff reminded children to walk and not run to prevent falls in the future. In addition, staff will remind children to use handrails when going up or down the steps of the apparatus to prevent falls in the future.


A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the facility representative, Victoria Garcia.


END OF REPORT: PAGE 2 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
LIC809 (FAS) - (06/04)
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