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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191222458
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:56:30 PM

Document Has Been Signed on 09/26/2024 01:56 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:LA CRESCENTA PRESBYTERIAN CTR. FOR CHILDREN/INFANTFACILITY NUMBER:
191222458
ADMINISTRATOR/
DIRECTOR:
PATRICIA CHAMBERSFACILITY TYPE:
830
ADDRESS:2902 MONTROSE AVE.TELEPHONE:
(818) 249-8124
CITY:LA CRESCENTASTATE: CAZIP CODE:
91214
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 12DATE:
09/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:29 PM
MET WITH:Julia Larson TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPA) Shushanik Safaryan conducted an unannounced Case Management inspection for the incident report received by the Department on 09/19/2024. Upon arrival at 12:30 pm, LPA met with Director Assistant , Julie Larson , to whom the purpose of the inspection was explained. Tour of the facility was provided. There were 12 children present with 7 staff members during the inspection.

On 09/18/24, an unusual incident report was submitted to the Department regarding a child sustaining an injury on the facility grounds. During the transition from lunch to nap time , child from the toddler room was crawling out from under the table , when he lost his balance and bumped his face on the carpet floor . Child was seen by dentist and had 3 teeth pulled .

During the inspection LPA toured the classroom and observed area where the incident occurred. LPA observed carpet in the area were the incident took place and did not observe any hazards . Per Facility Representatives , table was removed after the incident to prevent children from crawling under. Based on the paperwork obtained and interviews , there were 10 children present with 4 staff members the day of the incident . LPA interviewed two staff members present during the inspection . Per one staff member, she observed the incident and saw C1 under the table . Per staff member child lost his balance and bumped his face on the carpet floor . Per second staff she did not observe the incident since she was getting a book. Per two staff members C1 was attended immediately and first aid was provided , and an ouch report was created for the child on the day of the injury and parents were notified .(Ouch report obtained during today's inspection).

Based on the information obtained , LPA determined that there was adequate supervision on the day of injury. Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit.

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 Assistant , Julie Larson and Copy of Report provided.

END OF REPORT

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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