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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020674
Report Date: 04/11/2023
Date Signed: 04/11/2023 11:53:42 AM

Document Has Been Signed on 04/11/2023 11:53 AM - 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: 13DATE:
04/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Rukmal Samaranayaka, LicenseeTIME COMPLETED:
12:15 PM
NARRATIVE
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On April 11, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the above facility. This is a subsequent visit from 04/04/2023. 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. 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.

During this inspection, LPA interviewed Staff #1 (S1), Staff #2 (S2), LPA attempted to interview Child #1 (C1), and LPA obtained a copy of San Gabriel Police Department (SGPD) incident report. Throughout my inspection LPA observed children being left in the classroom without supervision on multiple occasions.

Per neighbor #1 (N1), C1 was found unsupervised at 1033 S. San Gabriel Blvd at approximately 10:15am. Per S1, she did not know that C1 was missing until SGPD arrived at the facility and demonstrated a picture of C1. Per S1 that is when she realized that C1 had left the facility. Per N1, C1 was found by an estranged woman on the sidewalk who called 911. Per N1, the estranged woman stated that she observed C1 walking down the sidewalk alone. Based on the SGPD incident report, the child was returned to the facility at 10:48 AM. Per S2, the class was coming back from playing outside and thought that all the children had entered that facility. Per S2, once they entered the facility, they (S1 and S2) locked the doors. S2 stated that she did not realize C1 was missing until SGPD brought C1 back to the facility.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2023
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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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: CHILD'S WORLD SCHOOL
FACILITY NUMBER: 198020674
VISIT DATE: 04/11/2023
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Based on interviews conducted and observation the facility is being cited a Type A deficiency in accordance with Title 22 Regulations, 101229(a)(1). A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent.

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: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/11/2023 11:53 AM - It Cannot Be Edited


Created By: Monique Jessica Ayala On 04/11/2023 at 11:28 AM
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: CHILD'S WORLD SCHOOL
FACILITY NUMBER: 198020674

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1).
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Licensee will hold a staff meeting discussing supervision and will place a baby gate and an alarm on the door leading to the parking lot to ensure the safety of the children.
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Supervision shall include visual observation. This requirement was not met as evidence by: Based on interviews with S1, S2 and N1, C1 was found outside of the facility without supervision and was found by N1 who called 911. This posed an immediate health and safety risk to 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:Ana Chico
LICENSING EVALUATOR NAME:Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023


LIC809 (FAS) - (06/04)
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