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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021120
Report Date: 02/22/2024
Date Signed: 02/22/2024 11:24:02 AM

Document Has Been Signed on 02/22/2024 11:24 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:LIGHTED WINDOW PRESCHOOL.FACILITY NUMBER:
198021120
ADMINISTRATOR:JOHNSON, SUZIEFACILITY TYPE:
830
ADDRESS:1200 FOOTHILL BOULEVARDTELEPHONE:
(818) 590-7785
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY: 34TOTAL ENROLLED CHILDREN: 37CENSUS: 15DATE:
02/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Suzie Johnson TIME COMPLETED:
11:35 AM
NARRATIVE
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Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case management incident inspection for the purpose of following up on an incident reported to the Department on 01/30/2024. Upon arrival at 8:30 am, LPA met with Director Assistant Sandra Laiser , to whom the purpose of the inspection was explained. Director Suzie Johnson came in later . Tour was provided of the facility. There were children present during the time of inspection.

Census was taken. There were 15 children with 8 staff members.

On January 30, 2024, 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 LPA Safaryan determined that during outdoor play child tripped over, hitting her forehead on built in cement brick bench .

LPA interviewed Director and 5 staff members . LPA obtained incident report provided to the child parents , sign in sheet, pictures of the injury , email from the parent sent to the director .

Based on the staff interviews 3 staff members were present and observed the incident and could not reach the child on time to prevent the fall . Based on the staff interviews 2 staff members were unable to identify reason for the tripping .

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2024
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: LIGHTED WINDOW PRESCHOOL.
FACILITY NUMBER: 198021120
VISIT DATE: 02/22/2024
NARRATIVE
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At 10:00 am LPA toured outdoor area where incident happened and observed rubber mat that was covering cement part of the play area separated on some areas which can cause tripping hazard to the children in care , which poses potential Health and Safety risk to children's in care (pictures were taken ).

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made by a licensing representative.

Exit interview was conducted with Facility Representative ,Suzie Johnson at 11:30 am on 02/22/2024.Plan of corrections were developed and copy of report and appeal rights were provided .

END OF REPORT

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/22/2024 11:24 AM - It Cannot Be Edited


Created By: Shushanik Safaryan On 02/22/2024 at 10:54 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: LIGHTED WINDOW PRESCHOOL.
FACILITY NUMBER: 198021120

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/29/2024
Section Cited
CCR
101238.2(d)(1)

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101238.2 Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained:
(1) In a safe condition for the activities planned.
This requirement is not met evidenced by :
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 Per licensee she had an estimate done regarding changing separated in pieces rubber mat to new rubber material and cover brick part of the bench with rubber material to prevent injuries . As of right now licensee will add rubber pieces to make sure it is one piece ,and morning person will make sure it is always in one piece condition . Liensee will send a o
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Based on the observations and interview
licensee did not comply with regulation cited above, the rubber mat on the outdoor play area had separated creating tripping hazard , which poses potential Health and Safety risk to children in care .
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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:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024


LIC809 (FAS) - (06/04)
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