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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191802051
Report Date: 04/05/2024
Date Signed: 04/05/2024 02:59:07 PM

Document Has Been Signed on 04/05/2024 02:59 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 SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:SALVATION ARMY DAY CARE CTRFACILITY NUMBER:
191802051
ADMINISTRATOR/
DIRECTOR:
MARIA RODRIGUEZFACILITY TYPE:
850
ADDRESS:836 STANFORD AVETELEPHONE:
(213) 623-9022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90021
CAPACITY: 150TOTAL ENROLLED CHILDREN: 150CENSUS: 73DATE:
04/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Maria RodriguezTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 4/5/24 at 12:30 PM Licensing Program Analysts (LPA) Claudia Kam and Katrina Chicote conducted an Unannounced Case management Inspection to follow up on an incident that was reported to the Department on 3/12/24. Upon arrival, LPAs announced purpose of inspection and met with Facility Representative, who granted entry to facility. Census was taken.

On 3/12/24, an incident was reported to The Department where a child sustained an injury while in care. The facility reported this incident to the Department within the required 24 hours and submitted written report within seven days.

During this inspection LPAs interviewed staff, observed playground where the incident took place. Director informed Licensing that a child hurt his right arm when he fell during recess. Teachers observed incident and they applied immediate first aid, by cleaning wound and putting the arm in a sling. Paramedics and parent were contacted and observed the injury. Child went in the ambulance and was treated at the hospital. The doctor has prescribed an arm sling and was released to return to care. Child returned to care and continues to play and participate in daily activities. LPAs unable to observe child as he was not present at the time of visit. Based on the information obtained and LPAs observation LPAs determined there was adequate supervision and Facility Representatives made necessary adjustments after incident.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today.
A notice of site visit was given and must remain posted for 30 days.

Exit interview was conducted and report was reviewed with the Facility Representative Maria Rodriguez.
Report Ends - Page 1 of 1

SUPERVISORS NAME: Denise Gibbs
LICENSING EVALUATOR NAME: Claudia Kam
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2024
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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