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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021205
Report Date: 08/23/2024
Date Signed: 08/23/2024 11:31:04 AM

Document Has Been Signed on 08/23/2024 11:31 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:HART PRESCHOOLFACILITY NUMBER:
198021205
ADMINISTRATOR/
DIRECTOR:
MONIQUE ORNELASFACILITY TYPE:
850
ADDRESS:859 S. RAYMOND AVE.TELEPHONE:
(213) 422-2176
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 28DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH: Emily Laguna TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 08/23/24 , at 10:30 am Licensing Program Analysts (LPA) Shushanik Safaryan conducted an unannounced Case Management inspection for the purpose for the following up on an unusual incident report received by the Department . Upon arrival at 10:30 am, LPA met with Facility Representative, Emily Laguna , to whom the purpose of the inspection was explained. Tour of the facility was provided. There were 28 children present during the inspection.

On 05/06/24, 07/11/24 an unusual incident reports were submitted to the Department regarding children sustaining an injury on the facility grounds . The facility reported the incident within the required 24- hour time frame.



On 05/06/24 Facility reported child #1 was playing with toys when toy fell under the table , when child was trying to get when tripped on a chair .

On 07/11/24 Facility reported child #2 was running in the classroom when he fell and hit his mouth area on the corner of the table .

During the visit LPA obtained copies of sign in/out sheets for all 2 incidents .Ratio and staffing were in accordance with Title 22 Code of Regulations at the time of the incidents. During the tour LPA examined the areas where the incidents took place, no obstructions were observed .

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when these incidents occurred. Therefore, there are no deficiencies being cited.


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

Exit interview conducted with the Director and Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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