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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191599892
Report Date: 10/16/2024
Date Signed: 10/16/2024 01:19:30 PM

Document Has Been Signed on 10/16/2024 01:19 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:WING LANE ELEMENTARYFACILITY NUMBER:
191599892
ADMINISTRATOR/
DIRECTOR:		M. YOKOYAMA, R. KHANNAFACILITY TYPE:
850
ADDRESS:16605 WING LANETELEPHONE:
(626) 933-5937
CITY:VALINDASTATE: CAZIP CODE:
91744
CAPACITY: 24TOTAL ENROLLED CHILDREN: 19CENSUS: 16DATE:
10/16/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Monica JarvisTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On October 16, 2024, at 9:15 am Licensing Program Analysts (LPAs) Carolyn Tuba and Mariah Aguirre conducted a case management licensee-initiated inspection. Covid risk assessment was conducted. LPAs met with Manager, Monica Jarvis. LPAs observed and took a census of 16 children with 3 staff in classroom Head Start (H1).

The Manager submitted an Unusual Incident Report (UIR) on 10/11/2024 informing the Department that the existing portable had been replaced with a new one. LPAs had entered the portable to inspect and take measurements, however during the course of the visit LPAs learned that during the years of “2009” – “2013” there was a decrease in capacity from 44 to 24. The classroom Head Start “H1” is currently the only portable on site that is licensed. The new portable does not have any children in care at this time. LPAs advised the Manager that she will need to submit an updated application, facility sketch, fire clearance and payment for the increase in capacity. LPAs were unable to complete the visit and provided the Manager the information of the LPA in charge of the intake unit.

During this investigation LPAs learned that the current license posted in classroom H1 did not have the correct capacity of 24 and so LPAs printed a new license to be posted on the parent board.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Manager, Monica Jarvis.
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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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