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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198400920
Report Date: 06/19/2025
Date Signed: 06/19/2025 03:31:27 PM

Document Has Been Signed on 06/19/2025 03:31 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:NOAH'S PLACE LA-WESTERNFACILITY NUMBER:
198400920
ADMINISTRATOR/
DIRECTOR:		CARDENAS, YECENIAFACILITY TYPE:
860
ADDRESS:5022 S WESTERN AVENUETELEPHONE:
(425) 314-5866
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY: 36TOTAL ENROLLED CHILDREN: 32CENSUS: 0DATE:
06/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Yecenia Baltazar-CardenasTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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On 6/19/25, Licensing Program Analysts (LPAs) L. Voong and T. Tran conducted an unannounced case management-incident visit at the above facility. LPAs announced the purpose of today’s visit and were granted into the facility by the Director, Yesenia Baltazar-Cardenas and toured the facility. There were no children present during today’s inspection.

The facility submitted a written UIR to the department on 6/6/25 regarding an incident that occurred on 6/5/25. On June 6, 2025, the facility submitted a UIR, stating that child was left unsupervised outside. A staff (S4) found child (C1) to and returned C1 to classroom.

During today's visit LPA Voong conducted interviews with staff and LPA Tran reviewed children and staff files. LPAs reviewed video surveillance and obtained Summary of Actions report/document and other pertinent information.

Based on the facts presented and the information gathered during the interviews and video surveillance, on 6/5/25, there were 9 children with three staff in the toddler yard. There were also two other classes outside: infant and preschool in separate play yards. Around 11:00am, during the transition from outside to inside, C1 was left outside alone while three staff and the rest of the children went into the classroom. C1 was left outside at the play area for about 6 minutes and was found alone by the preschool teacher. According to the available information, this incident was the result of a Title 22 violation for lack of care and supervision.

Facility conducted a staff meeting/training to discuss proper care and supervision during transition time. The copy of the agenda of the meeting/training regarding care and supervision and the list of attendees with their signatures were provided to LPAs on today’s visit.

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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Linda Voong
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2025
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 4
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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: NOAH'S PLACE LA-WESTERN
FACILITY NUMBER: 198400920
VISIT DATE: 06/19/2025
NARRATIVE
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On 6/19/25, LPAs received all the required POC documents and all citations have been cleared.

A Type B deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Yecenia Baltazar-Cardenas.

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NAME OF LICENSING PROGRAM MANAGER: Denise Gibbs
NAME OF LICENSING PROGRAM ANALYST: Linda Voong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 06/19/2025 03:31 PM - It Cannot Be Edited


Created By: Linda Voong On 06/19/2025 at 02:44 PM
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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: NOAH'S PLACE LA-WESTERN
FACILITY NUMBER: 198400920

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2025
Section Cited
CCR
101229(a)(1)

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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation. Staff failed to provide proper supervision while a child was left outside unsupervised.
This requirement is not met as evidenced by based on interviews staff failed to provide proper care and supervision for C1.
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Facility will conduct a staff meeting/training to discuss proper care and supervision during transition time. The copy of agenda of the meeting/training and the list of attendee's with their signatures were obtained during today's visit. POC has been cleared on 6/19/25
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On 6/5/25, about 11:00AM, C1 was left outside at the play yard area for about 6 minutes without any adult's supervision, which poses a 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.
Denise Gibbs
NAME OF LICENSING PROGRAM MANAGER:
Linda Voong
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2025


LIC809 (FAS) - (06/04)
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