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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191595072
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:15:26 PM

Document Has Been Signed on 09/21/2023 01:15 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:CLAREMONT UNITED CHURCH OF CHRIST, EARLY CHILDHOODFACILITY NUMBER:
191595072
ADMINISTRATOR:KNIGHT, KRISTYFACILITY TYPE:
830
ADDRESS:233 W. HARRISONTELEPHONE:
(909) 624-2916
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 32TOTAL ENROLLED CHILDREN: 35CENSUS: 7DATE:
09/21/2023
TYPE OF VISIT:Case Management - Infectious Disease OutbreakUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Kristy KnightTIME COMPLETED:
01:30 PM
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On 9/21/2023 an unannounced Case Management-Incident inspection was conducted by Licensing Program Analyst, (LPA) Carolyn Tuba who was following-up on an Unusual Incident Report. Covid risk assessment was conducted, and LPA wore appropriate gear. LPA met with Director, Kristy Knight. Director guided LPA on a tour of the infant program and took a census of 7 children with 4 staff.

There were 3 cases of Covid confirmed on 9/11/2023, 9/13/2023 and 9/18/2023 and was reported to the Department on 09/18/2023 via a written report emailed to Community Care Licensing Department. The facility reported the incident in a timely manner. LPA interviewed Director and she confirmed that staff and families were informed. Should anyone test positive then they need to quarantine for 5 days. The Department of Health was notified but they informed Director to call in after 5 positive cases. The facility conducted deep cleaning and disinfecting of the facility, including toys and classrooms. Mask wearing has been encouraged and parents have been told to Covid test children at home. Director stated that children and staff will be sent home if they display any symptoms.

No citations are being issued at this time.

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

Exit interview conducted and report was reviewed with the Director, Kristy Knight.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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