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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191502246
Report Date: 11/12/2024
Date Signed: 11/12/2024 02:01:43 PM

Document Has Been Signed on 11/12/2024 02:01 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:SIERRA MADRE COMMUNITY NURSERYFACILITY NUMBER:
191502246
ADMINISTRATOR/
DIRECTOR:
AMY MC GINNISFACILITY TYPE:
850
ADDRESS:701 E SIERRA MADRE BLVDTELEPHONE:
(626) 355-1655
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: 84TOTAL ENROLLED CHILDREN: 84CENSUS: 19DATE:
11/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:51 AM
MET WITH:Thais Anderson TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 11/12/24 at 11:45 am , Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management Inspection to follow up on the incident that took place on 10/24/24. LPA met with Director Thais Anderson , who guided LPA on a tour of the facility.
Census was taken. There were 19 children and 5 staff members.

On 10/24/24, an unusual incident report was submitted to the Department regarding child having seizure on the facility grounds .The Unusual Incident/ Injury Report was reported as required.



During the inspection , LPA talked to the Director and two staff members present the date of the incident . Per staff members , C1 did not have any prior medical issues reported to the facility . Per staff members , facility conducts health check in the mornings and no issues were reported regarding C1. C1 was observed to be healthy and was behaving as usual . During the lunch time , S1 noticed C1 was having seizure. Per S1 , C1 was able to recover , when another one was observed and 911 was called . Per staff members , parent was notified and arrived along with paramedics and C1 was taken to the hospital. Per staff members , C1 was back next scheduled day care day .

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when this incident occurred. No citations issued at this time .

Exit interview conducted with the Director , Thais Anderson and Copy of Report and Notice of Site visit was provided .

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.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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