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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021186
Report Date: 09/15/2025
Date Signed: 09/15/2025 12:04:16 PM

Document Has Been Signed on 09/15/2025 12:04 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LOS ANGELES COUNTY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
198021186
ADMINISTRATOR/
DIRECTOR:		AVILA, MARIA FRANCISCAFACILITY TYPE:
850
ADDRESS:1200 N STATE STREETTELEPHONE:
(323) 409-2240
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY: 68TOTAL ENROLLED CHILDREN: 47CENSUS: 29DATE:
09/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Director Evelin Hernandez TIME VISIT/
INSPECTION COMPLETED:
12:25 PM
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On Monday, September 15, 2025, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced case management inspection to follow up with an incident that was reported to the department. LPA met with Director Evelin Hernandez who guided LPA Perry on a tour of the facility. Census was taken.

On July 24, 2025, it was self-reported to the department that on July 23, 2025, that C#1 sustained an injury while outdoors (older preschool play yard). The incident was reported to the Department within the 24-hour period. Throughout the course of the investigation, LPA Perry conducted interviews, obtained declaration, pertinent documents and photos.

On July 23, 2025, at approximately 11:18 AM, a child in care sustained an injury while outdoors (older preschool play yard). The child jumped, lost balance, and fell. Staff were present during the incident, observed the incident and responded immediately. The child did indicate to S#1 that her leg was hurting. First aid was applied by S#1, including the use of an ice pack. The child was monitored throughout the day. During nap time, S#1 observed that the child’s ankle was swelling. Staff continued to closely monitor the child to ensure her comfort and safety. At that time, the facility contacted the child’s parent to notify them of the incident. Parent #1 arrived later and stated that she would take the child to urgent care to follow up. Later, it was confirmed that the child had sustained a fractured ankle. The child returned to the facility at a later date with a medical boot and documentation from the physician stating no restrictions just to be mindful of C#1 not to jump nor run.

Based off interviews and documentation, staff provided immediate first aid (ice pack) and monitored the child. Swelling was documented, and staff notified the parent promptly. Parent was advised to seek medical care and confirmed child was taken to urgent care via a doctor’s note, and a confirmation call from C#1’s parent the following day. Facility followed Title 22 regulations by ensuring immediate parent notification,

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: LOS ANGELES COUNTY CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 198021186
VISIT DATE: 09/15/2025
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documenting the incident, and reporting to Community Care Licensing. The director communicated with the parent and confirmed updates regarding the child’s medical condition. Based on review, the incident is determined to be an accident.

Currently the facility is in compliance with Title 22 regulations and no deficiencies are being cited.

An exit interview was conducted with Director Evelin Hernandez and a copy of this report was provided along with Appeal Rights. Notice of Site Visit was provided and must be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Staicy Perry
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2025
LIC809 (FAS) - (06/04)
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