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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020405
Report Date: 01/31/2025
Date Signed: 01/31/2025 02:23:20 PM

Document Has Been Signed on 01/31/2025 02:23 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: 115CENSUS: 99DATE:
01/31/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Stephanny Lemus, Health and Safety DirectorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management inspection on 01/31/25 at 12:00 PM, due to an incident that occurred on 11/26/24. Upon LPA’s arrival to the facility LPA met with Stephanny Lemus, Health and Safety Director who guided LPA on a tour of the facility. The licensee also operates an infant program (198020404) on the same premises. During this inspection 99 children were present in the facility with 24 staff.

Alleged Incident took place on Tuesday 11/26/24. However, facility was informed about the injury on 12/02/24. Incident was reported via phone next day on 12/03/24. 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 12/09/24. The facility reported the incident within the required 24 hour time frame.

LPA observed the area where alleged incident took place. LPA conducted an interview with staff#1. During this inspection three staff who were present in the classroom when this incident occurred, they were not present in the facility. LPA obtained copies of email communication between school and child#1 parents and doctor notes.

Per staff #1, the incident occurred on 11/26/24 at 2:56 p.m.. Per staff#1, child#1 stubbed right toe on a shelf in the classroom. Staff#2 and staff#3 removed child#1’s sock and did not notice any bruising or swelling on the foot. Ice was applied. Parents were informed. Per staff#1, teacher noticed towards the end of the day child#1 was favoring the foot that was stubbed. Child#1 was picked up at 3:47 p.m.. Child#1 returned school on 12/02/24 with a boot. Per staff#1, child#1 was taken to urgent Care on 11/27/24 and they thought might had a fractured metatarsal. Per staff#1, child#1 was taken to Orthopedic on 12/11/24, and child was diagnosed nondisplaced fracture of first metatarsal bone, right foot, initial encounter for closed fracture and pain. Child#1 had soft cast for two weeks from 12/11/24.
REPORT CONTINUES ON NEXT PAGE 1 OF 2
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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 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: 01/31/2025
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LPA accessed where alleged incident occurred and did not observe any hazards. A picture was taken. Ratio and staffing were in accordance with Title 22 Code of Regulations at the time of the incident. On 11/26/24 at the time of incident there were 11 children with 4 staff in the classroom where incident occurred.

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 incident 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 this incident 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 Stephanny Lemus, Health and Safety Director.


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

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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