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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501974
Report Date: 10/04/2021
Date Signed: 10/04/2021 02:04:47 PM

Document Has Been Signed on 10/04/2021 02:04 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:KATHY KREDEL NURSERY SCHOOLFACILITY NUMBER:
191501974
ADMINISTRATOR:GWEN BLACKMONFACILITY TYPE:
850
ADDRESS:300 WEST HUNTINGTON DRIVETELEPHONE:
(626) 574-3524
CITY:ARCADIASTATE: CAZIP CODE:
91007
CAPACITY: 71TOTAL ENROLLED CHILDREN: 0CENSUS: 42DATE:
10/04/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Gwen Blackmon TIME COMPLETED:
02:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 09/23/21. LPA met with Director, Gwen Blackmon, who guided LPA on a tour of the preschool at approximately 11:48 AM.

At the time of the tour, LPA observed 08 children with 01 staff in the Pink Room, 14 children with 03 staff in the Orange Room, 8 children with 02 staff in the Yellow Room and 12 children with 02 staff in the Blue Room. Staff to children ratios were observed to be in accordance with Title 22 Regulations.

The incident that occurred on Thursday, 09/23/21, was reported to the Department on Friday, 09/24/21 via telephone. The facility reported the incident in a timely manner. LPA conducted interviews and obtained documentation during this visit.

Based on the information obtained during this inspection, it was found that a child left a classroom alone without staff knowing. The child was found on the large outdoor playground by a teacher from another classroom. It is determined that the child was not being supervised by any staff for approximately 5 to 10 minutes; this was an immediate risk to the health and safety of the child. The staff from the Blue Room was not aware the child was not in the classroom until they called on the child for a table activity. The child was brought back to the classroom by office staff.

Upon receipt of this report, the licensee shall post any licensing report documenting a type “A” citation. This must remain posted for 30 days during the hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of any newly enrolled children in care for one year. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

*REPORT CONTINUES ON NEXT PAGE
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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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Document Has Been Signed on 10/04/2021 02:04 PM - It Cannot Be Edited


Created By: Judy Mora On 10/04/2021 at 01:19 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: KATHY KREDEL NURSERY SCHOOL
FACILITY NUMBER: 191501974

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/05/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by
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Director states they will send an email to all parents about ensuring that all gates and doors are closed behind them. Director states she is going to look into getting door alarms for all classrooms to that staff and parents are aware of door opening. Staff will have a refresher on supervision using CCLD video. POC due date: 10/11/21.
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the incident which occurred on 09/23/21 when a child was found outdoors by a teacher from another classroom. It is determined that the child was left unsupervised by any staff for approximately 5- 10 minutes. This was an immediate risk to the health and safety 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:Judy Mora
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2021


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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: KATHY KREDEL NURSERY SCHOOL
FACILITY NUMBER: 191501974
VISIT DATE: 10/04/2021
NARRATIVE
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The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Deficiency that is being cited needs to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – was provided and must remain posted for 30 days.

Exit interview was conducted with Director. Appeal rights explained & provided.




*END OF REPORT
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC809 (FAS) - (06/04)
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