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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020404
Report Date: 01/09/2024
Date Signed: 01/09/2024 02:42:07 PM

Document Has Been Signed on 01/09/2024 02:42 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:DISNEY CHILDREN'S CENTERFACILITY NUMBER:
198020404
ADMINISTRATOR:ELISHA GONZALEZFACILITY TYPE:
830
ADDRESS:625 PAULA STTELEPHONE:
(818) 931-5437
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 31DATE:
01/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elisha Gonzalez, DirectorTIME COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management- incident inspection on 01/09/24 at 10:00 AM, due to an incident that occurred on Tuesday, 01/02/24. LPA met with Elisha Gonzales, Director who guided analyst on a tour of the facility.

Alleged Incident took place on 01/02/2024. Incident was reported via telephone next working day. The written incident report was received by email on Friday 01/05/2024. The facility reported the incident within the required 24 hour time frame.

LPA observed the area where alleged incident took place. LPA conducted interviews with five staff. LPA obtained eight staff written statement regarding this incident.

Per staff#3, she observed child#1 in the classroom at 9:39 a.m.

Per staff #6 written statement, at 9:49 am, on 01/02/24, she left the 5/6 room to go out on her break. As she approached the 3/4 yard gate, she noticed a child on the little Tykes plastic slide structure.

Per staff#1, on 01/02/24, around 9:46 am, while finishing setting up the 3/4 yard, crossed path with staff#7 on the 3/4 to 1/2 outdoor gate. Per staff#1, at that time she did not observe any child on the yard.

Per staff#7 written statement, on 01/02/24, she took her morning break between 9:40 AM to 9:55 AM, as she was coming back encountered staff#1 by the 1/2 yard area and went inside the Room 3. Per staff#7, she did not see when and how child #1 stepped out of classroom.

Based on staff interviews and written statement, on 01/02/24 child#1 left classroom, and was alone and unsupervised on outdoor yard approximately from 9:46 a.m. to 9:49 a.m..
REPORT CONTINUES ON NEXT PAGE 1 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: DISNEY CHILDREN'S CENTER
FACILITY NUMBER: 198020404
VISIT DATE: 01/09/2024
NARRATIVE
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Ratio and staffing were in accordance of Title 22 Code of Regulations at the time of the incident.

LPA issued the Confidential Names List (LIC 811) to the licensee during this inspection. The Confidential Names List documents the staff and children involved with the incidents documented in this report.

Based on this information, the following deficiency listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

LPA Eivazian informed Director, Elisha Gonzalez that this report dated 01/09/2024 document(s) 1 Type A citation. Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Eivazian informed the Director, Elisha Gonzalez to provide a copy of this licensing report dated 01/09/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Director, Elisha Gonzales at 1:30 PM..



REPORT END 2 of 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/09/2024 02:42 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 01/09/2024 at 01:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DISNEY CHILDREN'S CENTER
FACILITY NUMBER: 198020404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/10/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, etc...
This requirement was not met as evidenced by...
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Per director, Elisha Gonzalez, a meeting was held with lead teachers on 01/03/24 and emphasized on supervision. A meeting will be held on 01/11/24 to train all staff on active supervision and transitions.
A written plan will be submitted to LPA by 01/10/24.
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Based on staff interviews, on 01/02/24 approximately from 9:46 a.m. to 9:49 a.m., child#1 was alone and unsupervised on outdoor yard. This poses an immediate health, safety and personal right risk to the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Christina Gabelman
LICENSING EVALUATOR NAME:Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
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