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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020044
Report Date: 07/08/2024
Date Signed: 07/08/2024 11:53:53 AM

Document Has Been Signed on 07/08/2024 11:53 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:ALVAREZ LEIVA FAMILY CHILD CAREFACILITY NUMBER:
198020044
ADMINISTRATOR/
DIRECTOR:		ALVAREZ LEIVA,S & CARLOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 448-4169
CITY:DOWNEYSTATE: CAZIP CODE:
90240
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 9DATE:
07/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Licensee Siomara Alvarez LeivaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On July 8, 2024 at 10:20 am, Licensing Program Analyst (LPA) Angelica Wallin conducted a Case Management Incident inspection. This inspection is regarding an incident that took place on June 24, 2024 in which a child while playing soccer tripped and fell into the wooden metal gate surrounding the outdoor play area and hit his forehead. LPA met with licensee, Siomara Alvarez Leiva, who provided information and assistance during inspection. A census of 9 children and one staff was taken.

During the course of the inspection, LPA reviewed two children’s files, two staff files, collected LIC 624 and conducted interviews with two children, one staff, and licensee. During inspection, LPA evaluated outdoor play area where incident occurred. LPA observed age-appropriate playground area and toys for children in care. LPA observed outdoor play area is enclosed and no hazards present to children in care. Per licensee, child was running with Croc shoes and tripped while playing and fell into the metal part of the sliding gate in the outdoor front yard play area. Per children and staff interviews, it was confirmed that child sustained injury by running while playing in outdoor playground and falling into metal portion of sliding gate in the outdoor front yard play area. Per children and staff interviews, direct supervision was maintained during the incident and immediate assistance was provided.

Based on the available information: observations, interviews with children parent and staff, no Title 22 deficiencies cited. LPAs discussed with director, preventative measures to be implemented during outdoor play. Per licensee, she spoke with parents regarding use of Croc shoes during outdoor play. LPA provided consultation regarding updating facility outdoor safety policy regarding closed toes shoes to prevent any further tripping hazards. Per licensee, written letter to parents regarding use of Croc shoes during outdoor play to be sent with return acknowledgment signature from parents.

The content of this report was read and discussed in detail at the time of inspection with licensee, Siomara Alvarez Leiva. An exit interview was conducted, a notice of site visit to be posted for 30 days provided.

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Angelica Wallin
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2024
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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