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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198016464
Report Date: 04/16/2024
Date Signed: 04/16/2024 12:17:42 PM

Document Has Been Signed on 04/16/2024 12:17 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:VAN LEEUWEN FAMILY CHILD CAREFACILITY NUMBER:
198016464
ADMINISTRATOR/
DIRECTOR:		VAN LEEUWEN, TRINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 522-5192
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:17 AM
MET WITH:VAN LEEUWEN, TRINA / LICENSEETIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Ashley Calderon and Jeanette Estrada conducted a case management inspection visit regarding incident that was reported to CCLD on 4/08/24, involving two children, which one was was inappropriately touched. Per licensee, child #1 told mother of the incident over the weekend and on 4/7/24 mother spoke to Licensee regarding incident. It was reported that four children were in the playroom area watching tv, when incident occurred.

When LPA's interviewed licensee, the licensee stated the child #1 did not seem to act a different way, be sad or did not say anything regarding incident. Licensee stated checking on the children every 15-20 minutes. Per licensee, child #1 was coming to the child care home during their school spring break: March 25-29,2024, Child #1 was not present during today's visit. Date of alleged incident Thursday March 28,2024. LPA attempt to interview Child #2, licensee stated child's mother did not want any personnel's speaking to child.

Further interviews will be conducted for parents of Child #1 and Child #2 as part of investigation.

Exit interview conducted with licensee and a notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Ashley Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
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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