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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019065
Report Date: 09/01/2023
Date Signed: 09/01/2023 01:04:24 PM

Document Has Been Signed on 09/01/2023 01:04 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BLOOMING FLOWERS CHILD CARE CENTERFACILITY NUMBER:
198019065
ADMINISTRATOR:THOMAS, JAZMYNEFACILITY TYPE:
850
ADDRESS:680 E. ARROW HIGHWAYTELEPHONE:
(909) 399-0003
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY: 60TOTAL ENROLLED CHILDREN: 33CENSUS: 14DATE:
09/01/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Anntoinette JordanTIME COMPLETED:
01:30 PM
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On 9/1/2023, Licensing Program Analyst (LPA), Carolyn Tuba conducted an unannounced POC (plan of correction) inspection to ensure the one (1) -Type B deficiencies cited on 8/10/2023 have been cleared. A COVID risk assessment was conducted upon entry. LPA met with Director, Anntoinette Jordan, who guided LPA on a census of 14 children and 2 staff in care.

Director provided LPA proof of Mandated Reporting Certificate for staff that will expire on August 28, 2023.

LPA cleared the deficiencies on this date and provided a copy of issued POC clearance letter during the visit. At this time, the facility is in compliance with California Code of Regulations Title 22. Therefore, no deficiencies are being cited.

A notice of site visit was given to Director and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.



Exit interview conducted and report was reviewed with the Director, Anntoinette Jordan.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Carolyn Tuba
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2023
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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