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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191593920
Report Date: 05/15/2025
Date Signed: 05/15/2025 12:00:36 PM

Document Has Been Signed on 05/15/2025 12:00 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:CLAREMONT PRESBYTERIAN CHURCH CHILDREN'S CENTERFACILITY NUMBER:
191593920
ADMINISTRATOR/
DIRECTOR:		SASKIA (SACHA) LORDFACILITY TYPE:
830
ADDRESS:1111 NO. MOUNTAINTELEPHONE:
(909) 626-6261
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 38TOTAL ENROLLED CHILDREN: 37CENSUS: 25DATE:
05/15/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Sacha LordTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On May 15, 2025, at 8:30 am Licensing Program Analyst (LPA) Carolyn Tuba and conducted a case management inspection visit due to an incident that was self-reported by the facility. LPA met with Director, Sacha Lord who provided a tour and obtained a census of 25 infant children with 8 staff members.

An incident was submitted by the facility on 04/14/2025 via phone call and the written Unusual Incident Report (UIR) was later submitted via email on 04/14/2025. The incident occurred on 4/11/2025 at approximately 10:15 am.

The incident was reported to the Department within the required 24 hours of occurrence.

The incident was reported due to concerns that Child #1 (C1) may have eaten wild mushrooms that were found in the playground area of the infant yard (LPA took photos of the area). Staff #1 (S1) stated that C1 was found playing in that area near where the wild mushrooms were located and according to S1 noticed dirt around C1’s mouth. S1 advised Staff #2 (S2) as a precaution that C1 may have eaten the wild mushrooms. C1 was checked by S1 and S2 and found no evidence of C1 having eaten any mushrooms, however reported it to the Director. S1, S2 and Director observed C1 for any behavior or physical changes. Parent #1 (P1) of C1 was notified at approximately 11:00 am and then picked up at 11:38 am and taken to urgent care. An accident report was provided to P1, and LPA obtained a copy. Director stated that she took a sample of the wild mushrooms to the local Armstrong Garden Center and California Botanic Center in Claremont to obtain information about the mushrooms found but could not get any details if the mushrooms were

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2025
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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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 CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CLAREMONT PRESBYTERIAN CHURCH CHILDREN'S CENTER
FACILITY NUMBER: 191593920
VISIT DATE: 05/15/2025
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poisonous. The Poison Control was also called by the Director on 4/11/2025, and they could not provide any information other than to suggest having C1 seen by medical professionals.

During the visit LPA attempted to call Parent #1 (P1) who was not available for interview and C1 was too young to be interviewed. LPA obtained a copy of the medical report dated 4/11/2025 and according to the report no medical attention was given other then to observe C1 for any changes. According to Director who followed with P1 over the weekend stated that C1 was not demonstrating any changes and there were no discomfort or changes in their stool or appetite. Also, according to the Director, C1 returned to school on 4/14/2025.

The Director stated while the staff has always gone out to observe the playground for any hazards, they have since moved crates that toys were kept in from near the area where wild mushrooms were found and will keep an eye out for any wild mushrooms found on the playground will be removed. Director also stated that a gardener comes every Wednesday to clean, and LPA advised to let the gardener know to be on the lookout for any wild mushrooms or hazardous plants. LPA observed that there were no wild mushrooms currently found outside on the playground, however a staff member found some outside of the playground area today and removed them. (LPA took a photo).

No citations are being issued during today's visit.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Director, Sacha Lord.

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NAME OF LICENSING PROGRAM MANAGER: Katrina Chicote
NAME OF LICENSING PROGRAM ANALYST: Carolyn Tuba
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC809 (FAS) - (06/04)
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