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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198006098
Report Date: 07/28/2021
Date Signed: 07/28/2021 12:09:52 PM

Document Has Been Signed on 07/28/2021 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:RANCHO LOS AMIGOS CHILDREN'S CENTERFACILITY NUMBER:
198006098
ADMINISTRATOR:HELIA CASTELLONFACILITY TYPE:
850
ADDRESS:7755 GOLONDRINAS STREETTELEPHONE:
(562) 401-7981
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY: 59TOTAL ENROLLED CHILDREN: 0CENSUS: 38DATE:
07/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Helia Castellon, DirectorTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) T. Tran arrived at Rancho Los Amigos Children's Center to conduct a Case Management inspection that was self-reported on 06/18/2021. The Monterey Park South West Child Care Regional Office received the incident report on 6/21/2021.

LPA completed the files reviewed and obtained child's document. LPA conducted interviews with staff and other. Per center staff, when the incident occurred there was a staff supervised 12 children in care. During outdoor play, C1 was running around the play structure. Staff observed child tripped on the foot and fell face down on the rubber floor and sustained a scrape on the nose. Staff immediately attended to child and provided first aid. Parent was contacted. Based on the available information, this incident was not result in the Title 22 Regulations for Lack of Care and Supervision violation. No deficiency was cited.

The content of this report was read and discussed in detail with the noted person. Appeal Right was provided.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISORS NAME: Trevino Cochran
LICENSING EVALUATOR NAME: Tiffanie Tran
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2021
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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