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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501766
Report Date: 03/15/2024
Date Signed: 07/02/2024 09:15:39 AM

Document Has Been Signed on 07/02/2024 09:15 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GOOD SHEPHERD CHILDREN'S CENTER, THEFACILITY NUMBER:
191501766
ADMINISTRATOR:BROWN, LINDAFACILITY TYPE:
850
ADDRESS:400 W. DUARTE ROADTELEPHONE:
(626) 447-1249
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 56TOTAL ENROLLED CHILDREN: 56CENSUS: 51DATE:
03/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Cindy Ostry - Office ManagerTIME COMPLETED:
12:35 PM
NARRATIVE
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AMENDED REPORT: This report is being amended to remove information for a citation that was appealed and approved by the Department.

Licensing Program Analysts (LPAs) Nolan Tcheng and Saul Valenzuela conducted an unannounced Case Management inspection to follow up on an incident reported on 03/05/2024. Upon arrival at 8:30am, LPAs met with Office Manager Cindy Ostry, to whom the purpose of the inspection was explained. Tour of the facility was provided. There were children present during the time of inspection.


Census was taken. There were 51 children with 8 staff members.

During the inspection, it was disclosed that Staff #1 and Staff #2 (S2) were present in the classroom during the time of the incident. Upon file review, it was determined that Staff #2 does not have a criminal record clearance associated to the facility but does have an eligible criminal record clearance with facility number 191502426. LPA confirmed on the Agency database, Guardian, Staff #2's clearance is still eligible. File review determined that they meet education qualifications of teacher. Per Director, S2 is present on Tuesdays and started working for the facility on 02/06/2024. LPA discussed the LIC9182 Criminal background Clearance Transfer Request form and copy of ID being submitted to Regional Office for transfer.

An immediate civil penalty in the amount of $500 is being assessed. The civil penalty being assessed, including the authority for the citation and the amount assessed is attached on form LIC 421BG.

REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GOOD SHEPHERD CHILDREN'S CENTER, THE
FACILITY NUMBER: 191501766
VISIT DATE: 03/15/2024
NARRATIVE
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The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Linda Brown, at 12:20pm. Plan of corrections were developed and copy of Report provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/15/2024 12:22 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 03/15/2024 at 10:45 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: GOOD SHEPHERD CHILDREN'S CENTER, THE
FACILITY NUMBER: 191501766

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/18/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
(1) No child(ren) shall be left without the supervision of a teacher at any time.. Supervision shall include visual observation.

This requirement is not met as evidenced by:
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Per Director, they will conduct a staff meeting to review supervision. All staff will sign an attendance sheet, and meeting agenda will be submitted to LPA by POC date. Www.ccld.childcarevideos.org is being provided. All staff will watch the video titled: "Supervising Children in Child Care Centers"
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Based on interview and record review, Licensee did not ensure that child was supervised, and injury was sustained with no staff observing the incident. This posed an immediate risk to the health, safety, and personal rights of children in care.
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and complete summaries, to submit to LPA by POC date.
Type B
03/22/2024
Section Cited
CCR101170(e)(2)

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Criminal Record Clearance
(e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility (2) Request a transfer of a criminal record clearance...
This requirement is not met as evidenced by:
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Per Director, they will submit the LIC9182 Criminal Background Transfer Request form and ID to the regional office, to have Staff #2 associated.
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Based on interview and record review, Licensee did not ensure that Trinity Park-Tsai's eligble criminal recrod clearance was associated to the facility before starting to work on campus 02/06/2024. This posed a potential risk to the health, safety, and personal rights of 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:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024


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