<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598412
Report Date: 04/07/2025
Date Signed: 04/07/2025 11:12:49 AM

Document Has Been Signed on 04/07/2025 11:12 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ALMANSOR CENTER, THEFACILITY NUMBER:
191598412
ADMINISTRATOR/
DIRECTOR:		DIANE CONNELLFACILITY TYPE:
830
ADDRESS:1955 FREMONT AVETELEPHONE:
(323) 341-7768
CITY:S. PASADENASTATE: CAZIP CODE:
91030
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: 13DATE:
04/07/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Angela Barlow, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On April 7, 2025, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection. The purpose of the inspection is to follow up on an incident that was reported to the department on 04/02/2025; the incident occurred on 03/27/2025. The incident is a possible personal rights violation. LPA met with Director, Angela Barlow who guided LPA on a tour of the facility. LPA observed 13 infants/toddlers in care with 6 staff.

During the inspection LPA interviewed Staff #2 (S2) to Staff #4 (S4), obtained copy of written statements from S2 to S3, interviewed Parent #1 (P1) and obtained a copy of the facility roster. LPA was unable to interview Staff #1 (S1) as S1 is no longer employed at the facility. LPA called S1 and left a voicemail with call back number. LPA was unable to interview C1 as C1 is an infant and nonverbal.

During interviews, S2 stated that while dropping off lunch S2 observed C1 with masking tape around C1's shoes (tape went around from bottom of shoe to the top where velcro is). Per S2, S2 asked why S3 why C1 had tape on their shoes. Per S2, S3 stated that C1 kept taking their shoes off and S1 placed taped on C1 shoes to prevent C1 from taking the shoes off. Per S3, S3 noticed the tape on C1 shoes after nap time and asked who put tape on C1's shoes when S1 stated she did to prevent C1 from taking off their shoes. Per P1, P1 has not observed tape on C1's shoe during pick up time. Per P1, P1 did not observe any bruising on C1's feet/ankles. Per P1, he was notified the following day of the incident verbally by director.

Based on interviews conducted the facility is being cited a Type B deficiency in accordance with Title 22 Regulations, see LIC809D An exit interview was conducted and a copy if this report along with Appeal Rights was provided to the director. A Notice of Site Visit was provided and must be posted for 30 days.
NAME OF LICENSING PROGRAM MANAGER: Ana Chico
NAME OF LICENSING PROGRAM ANALYST: Monique Jessica Ayala
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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)
Page: 2 of 3
Document Has Been Signed on 04/07/2025 11:12 AM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 04/07/2025 at 10:41 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: ALMANSOR CENTER, THE
FACILITY NUMBER: 191598412

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/07/2025
Section Cited
CCR
101223(a)(2)

1
2
3
4
5
6
7
Personal Rights: The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment... This requirement was not met as evidence by: Based on interviews conducted with S2 and S3, it was disclosed that S1
1
2
3
4
5
6
7
The director has already held a staff meeting reviewing children's personal rights on 03/28/2025. Director has provided LPA with a copy of the meeting agenda and signatures of staff who attended. Per director, S1 was terminated as a result of the incident that occurred.
8
9
10
11
12
13
14
purposely taped C1's shoes to prevent C1 from continuing to take off their shoes. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ana Chico
NAME OF LICENSING PROGRAM MANAGER:
Monique Jessica Ayala
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 04/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3