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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020404
Report Date: 10/13/2025
Date Signed: 10/13/2025 02:14:54 PM

Document Has Been Signed on 10/13/2025 02:14 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/
DIRECTOR:		ELISHA GONZALEZFACILITY TYPE:
830
ADDRESS:625 PAULA STTELEPHONE:
(818) 931-5437
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 40DATE:
10/13/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Elisha Gonzales, DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management- incident inspection on 10/13/25 at 12:00 PM, due to an incident that occurred on Friday, 09/19/25. LPA met with Elisha Gozalez, Director who guided analyst on a tour of the facility. During this inspection 40 infants were present with 17 staff.

Alleged Incident took place on Friday, 09/19/25. Incident was reported via telephone on the same day, 09/19/25. The written incident report was received via email on 09/29/25. The facility reported the incident within the required 24-hour time frame.

On 09/19/25, an incident took place where child #1 was unknowingly fed child#2’s bottle which contains an ounce of breast milk and an ounce of formula by staff#2.

Based on staff#1 and staff#3 interviews today, staff#1 was inside the classroom, gave child#’2 bottle to staff#2 in the yard and stated this is child#2’s milk. At that time, staff#2 observed child#1 was fussy, checked the child#1’s feeding chart and noticed it was child#1’s feeding time. Per staff#1, she got the child#1’s bottle from fridge, warmed it up, took it outside to give it to staff#2 to feed the child#1, at that time staff#1 observed child#2’s empty bottle in staff#2’s hand. Staff#1 stated this is child#1’s bottle, at that point staff#2 found out child#1 was fed child#2’s bottle. Both parents were informed, child#1 was fine and no reaction after being fed the wrong bottle.

Per staff#3 and facility director, both staff#1 and staff#2 were written up and redid the infant feeding policy and procedure. LPA obtained copies of Infant feeding policy and procedure and staff#1 and staff#2 written statements regarding this incident.


REPORT CONTINUES ON NEXT PAGE 1 OF 2
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 10/13/2025
NARRATIVE
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Based upon the information above, LPA has determined that there was a violation of Child #1's personal rights, when child#1 was fed the incorrect bottle by Staff #2. This was an immediate risk to the health, safety, and personal rights of children in care.

LPA Eivazian informed Director, Elisha Gonzalez that this report dated 10/13/25, documents one Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, and personal rights of children in care.

Also, LPA Eivazian informed the Director to provide a copy of this licensing report dated 10/13/25, that documents any Type A citation, to parent/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 (LIC9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit 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 Gonzalez.


END OF REPORT 2 of 2
NAME OF LICENSING PROGRAM MANAGER: Christina Gabelman
NAME OF LICENSING PROGRAM ANALYST: Anomeh Eivazian
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/13/2025 02:14 PM - It Cannot Be Edited


Created By: Anomeh Eivazian On 10/13/2025 at 12:34 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: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/14/2025
Section Cited
CCR
101223(a)(2)

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Personal Rights
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
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Per Director, continuing training with staff for infant feeding policy and procedure.

A written plan will be submitted to LPA by 10/14/25.
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Based on interviews and record review, Licensee did not ensure that Child #1 was provided their own bottle, and was fed mix breast milk and formula for Child #2 on 09/19/25.
This poses an immediate risk to the health, safety, and personal rights of 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.
Christina Gabelman
NAME OF LICENSING PROGRAM MANAGER:
Anomeh Eivazian
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2025


LIC809 (FAS) - (06/04)
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