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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494575
Report Date: 05/18/2022
Date Signed: 05/18/2022 09:55:44 AM

Document Has Been Signed on 05/18/2022 09:55 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: 26CENSUS: 17DATE:
05/18/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Jacqueline Lopez, Designated person in Charge. TIME COMPLETED:
10:00 AM
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On 05/18/2022 at 7:50a.m., Licensing Program Analyst (LPA) Denise Miranda arrived at Devonshire Infant Center located at 21203 Devonshire Street, Chatsworth, CA 91311, for the purpose of a Case Management-Plan of Correction Visit. LPA verified that all adults present at the facility have obtained criminal record clearances and are associated to the facility. The Facility operational hours is from: 6:30am to 6:00pm, Monday-Friday.

On 05/11/2022, LPA conducted subsequent visit to deliver the final investigation complaint # 30-CC-20220324145344, the facility was cited in violation of Title 22: CCR Title 22, Division 12 Chapter 1 Article 02. Infant Care Center 111416.5 (b) – Staff-Infant Ratio and 5/12/2022 Facility was cited for repeat violation with civil penalty.



On 5/18/2022 Upon arrival, LPA Miranda met with Teachers: Laura Delgadillo and Nadia Pyarali and discussed the purpose of the visit.
LPA observed the following:
Classroom#1: LPA observed 04 infants with 02 Staff (Staff#1 and Staff#2)
Classroom#2: LPA observed 05 infants with 02 Staff (Staff#3 and Staff#4)
Classroom # name Toddler: LPA observed no children or infants and no Staff present on this classroom. (Facility does not have toddler component).

At 8:10am LPA met Jacqueline Lopez, designated person in charge.
Also, LPA obtained the staff timesheet and sign in and out for the days 5/13/2022, 5/16/2022, 5/17/2022 and 5/18/2022. LPA reviewed documents and observed that facility was in compliance with Staff-Infant Ratio.
At 9:32am, Facility has 17 infants in care with 6 staff.
LPA observed that the deficiency has been corrected, cleared the deficiency, and provided a copy of a Cleared plan of correction (POC) .
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 197494575
VISIT DATE: 05/18/2022
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Also, LPA reviewed the form of lic9224 Acknowledgment Receipt that facility shall provided copies of the following reports: Complaint report dated on 5/11/2022 and report Case Management POC dated on 5/12/2022. LPA observed that an acknowledgement of the receipt of licensing reports form (LIC 9224) was signed by guardian/parents.

LPA observed copies of Notice of Site Visit – form LIC9213 dated on 5/11/2022 and 5/12/2022 posted at the infant’s Facility and Director’s office.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

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. Jacqueline Lopez along with Notice of Visit.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022
LIC809 (FAS) - (06/04)
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