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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191598968
Report Date: 02/29/2024
Date Signed: 02/29/2024 12:09:14 PM

Document Has Been Signed on 02/29/2024 12:09 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:EL MONTE CITY SCHOOL DISTRICT - LE GOREFACILITY NUMBER:
191598968
ADMINISTRATOR:AUDELIA MACIASFACILITY TYPE:
850
ADDRESS:11121 E. BRYANT RD.TELEPHONE:
(818) 575-2393
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 84TOTAL ENROLLED CHILDREN: 72CENSUS: 60DATE:
02/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Site Supervisor, Anzhela HirschTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced Case Management Incident Inspection to follow up on an incident that was reported to the department on 1/26/2024. A COVID 19 risk assessment was conducted. LPA met with Site Supervisor Anzela Hirsch ,who guided LPA on a tour of the facility. Census was taken.

On January 26th, 2024, an incident was self reported to the Department via Email by the facility who reported a child had bumped heads with another child and had a cut on eyebrow.



The report was reported within the required 24 hours and written report was submitted within the 7 days.

During the inspection, LPA Lopez conducted interviews with 2 staff and child and observed the area where incident took place. Incident was observed- child was provided with first aid and was monitored until they were picked up by parents and taken to the doctor. Child was cleared to come back to school with no restrictions.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with facility representative, Anzhela Hirsch.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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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