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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494575
Report Date: 04/08/2022
Date Signed: 04/08/2022 11:52:46 AM

Document Has Been Signed on 04/08/2022 11:52 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:DEVONSHIRE INFANT CENTERFACILITY NUMBER:
197494575
ADMINISTRATOR:MERADITH GRABLEFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY: 46TOTAL ENROLLED CHILDREN: 25CENSUS: 20DATE:
04/08/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Amalia Gutierrez, Director AssistantTIME COMPLETED:
10:46 AM
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On 04/08/2022 9:46AM, Licensing Program Analyst (LPA) Denise Miranda arrived at Devonshire Infant Center, to observe the corrections to the violation cited on 03/30/2022. LPA met with Amalia Gutierrez, Director Assistant, and discussed the purpose of the visit. Ms. Gutierrez guided LPA on a tour inside and outside of the facility. LPA confirmed that all adults working in the center have criminal record clearance.

LPA observed of the report dated on 3/30/2022 posted at wall of the infant room#2. On 3/30/2022 Facility was cited in violation of Title 22 – 101170 (j) Criminal Record Clearance. LPA reviewed the forms LIC9224 - Acknowledgment of Receipt of Licensing Reports signed by infant's parents.

During this inspection, LPA observed Ms. Tamarah Butler present at the facility. Ms. Tamarah Butler received her criminal record clearance on 4/5/2022.

LPA observed that the deficiency has been corrected, cleared the deficiency, and provided a copy of a Cleared plan of corection(POC) to Ms. Gutierrez.



The facility is operating in substantial compliance with the Title 22 Regulations at time of visit. No violations were cited. Copy of this report was provided to the Ms. Amalia Gutierrez along with Notice of Visit. An exit interview was conducted with Ms. Gutierez.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 04/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/08/2022
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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