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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020405
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:56:39 PM

Document Has Been Signed on 04/18/2024 02:56 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:
198020405
ADMINISTRATOR/
DIRECTOR:		ELISHA GONZALEZFACILITY TYPE:
850
ADDRESS:625 PAULA STTELEPHONE:
(818) 931-5437
CITY:GLENDALESTATE: CAZIP CODE:
91201
CAPACITY: 182TOTAL ENROLLED CHILDREN: 119CENSUS: 106DATE:
04/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:05 PM
MET WITH:Elisha Gonzalez, DirectorTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 04/18/24, at 12:05 PM, due to an incident that occurred on Friday, 04/05/24. Upon LPA’s arrival to the facility LPA met with Stephanny Lemus, Health and Safety Director. Shortly after, Elisha Gonzalez, Director arrived to the facility who guided LPA on a tour of the facility. The licensee also operates an infant program (198020404) on the same premises.

Alleged Incident took place on Friday 04/05/24. Incident was reported via phone same day on 04/05/24. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by email on Thursday 04/11/24. 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 copies of email communication between school and child#1 parents and attendance report for 04/05/24 where incident occurred.

LPA Eivazian conducted a phone interview with staff#1. Per staff#1, on 04/05/24 the incident occurred approximately at 8:55 AM. Per staff#1, three children were in dramatic play area and rest of the children were having AM snack. Per staff#1, child#1 just started running from dramatic area to art area while having a mop toy in hand, tripped, fell and hit forehead on the edge of the cubbies and sustained a cut on forehead. Per staff#1, first aid was applied, parent was contacted.

Per staff#4 and staff#5 interviews, child#1 was picked up at 9:31 AM and child#1 received four stiches. Child#1 was back at the school on Monday 04/08/24. Per staff interviews, they rearranged the classroom to prevent children from running in the classroom.
REPORT CONTINUES ON NEXT PAGE 1 OF 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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 2
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: 198020405
VISIT DATE: 04/18/2024
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LPA accessed where alleged incident occurred and did not observe any hazards. Ratio and staffing were in accordance with Title 22 Code of Regulations at the time of the incident. On 04/05/24 at the time of incident there were 7 children with 4 staff in the classroom where incident occurred.

On this date LPA also followed up on the incident that was reported on 03/04/24 via phone. The written incident report was received by email on 03/06/24. The facility reported the incident within the required 24 hour time frame.

Per facility director, they only had three cases of conjunctivitis (Pink eye) in a two week period and no other cases were reported.

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.

At this time, there is not a preponderance of evidence that shows that the facility was in violation with Title 22 Regulations when these incidents occurred. Therefore, there are no deficiencies being cited on this date.

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 Gonzalez.


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

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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