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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020674
Report Date: 04/04/2023
Date Signed: 04/04/2023 04:57:07 PM

Document Has Been Signed on 04/04/2023 04:57 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:CHILD'S WORLD SCHOOLFACILITY NUMBER:
198020674
ADMINISTRATOR:RUKMAL SAMARANAYAKAFACILITY TYPE:
850
ADDRESS:1027 S. SAN GABRIEL BLVD.TELEPHONE:
(626) 759-2639
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 11DATE:
04/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Rukmal Samaranayaka, LicenseeTIME COMPLETED:
05:15 PM
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On April 4, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. There is a school age license on the same premises, license number 198021017. LPA met with licensee who was supervising after school children on school age license side.

The purpose of the inspection is to follow up on an incident that occurred at the facility on 04/04/2023. The incident was reported timely to the department.

Brief summary of incident: Child #1 (c1) walked away from the facility unsupervised and the neighbor business found the child. The business called the police and they arrived at facility. Per licensee the incident occurred at approximately 10:30 AM to 10:45 AM. Per licensee, the police department did not leave a card/contact information.

LPA was unable to conduct interviews or review files as the facility was short staffed. LPA was able to interview the neighbor (interview on LIC812, confidential document), obtain pictures of the outside area of the facility and images of where C1 was found. At this time the above incident requires further investigation and the facility will not be cited any deficiencies at this time.

An exit interview was conducted and a copy of this report was provided to the licensee along with Notice of Site Visit and Appeal rights.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2023
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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