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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020970
Report Date: 09/23/2024
Date Signed: 09/23/2024 02:00:07 PM

Document Has Been Signed on 09/23/2024 02:00 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BLOSSOM GARDEN LEARNING ACADEMYFACILITY NUMBER:
198020970
ADMINISTRATOR/
DIRECTOR:		MEGHA SAHNIFACILITY TYPE:
850
ADDRESS:101 S. ATLANTIC BLVDTELEPHONE:
(626) 627-2318
CITY:ALHAMBRASTATE: CAZIP CODE:
91801
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 54DATE:
09/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Megha Sahni TIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Seung Lee conducted an unannounced case management inspection. Upon arrival LPA Lee met with Director Megha Sahni.

The purpose of the inspection was to obtain additional information regarding an incident reported by the facility on 09/12/2024. The incident occurred on 09/12/2024. During the inspection, LPA Lee conducted interviews, ,made observations, and reviewed documents regarding the incident.

On 09/12/2024, Child#1 sustained an injury during outside play time. The injury occurred when Child#1 put their finger near a closing door. During a previous inspection, LPA Lee observed where the injury occurred and also saw recorded footage that showed the incident.

The main entrance of the facility door is used by parents and staff and is located within the outdoor play area. After parents and staff go through the outside gate, the main entrance door into the facility shares the same space as the outdoor play space. The facility was in ratio when the incident occurred. Based on the information obtained and verified, there were 20 children playing outside with 2 staff members when Child#1 sustained the injury. Through the footage provided by the facility, LPA Lee observed that a parent had walked in through the main entrance. Right before the self closing door closed, Child#1 was observed quickly running up to the door area. About a few seconds after the door had closed, LPA Lee saw a staff member pick up Child#1 and move out of the camera shot. The 2 staff members who were outside were interviewed. Staff#1 who had picked up the child immediately in the footage, stated in an interview that they saw Child#1 going towards the door entrance but could not stop the child in time to prevent the injury. Staff#1 immediately notified the other staff members of the facility of the incident. The facility provided first aide and notified the parent of Child#1 on 09/12/24. The facility then called 911, who came to the facility and transported Child#1 to the hospital.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BLOSSOM GARDEN LEARNING ACADEMY
FACILITY NUMBER: 198020970
VISIT DATE: 09/23/2024
NARRATIVE
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Child#1's injury did require further treatment after 09/12/2024. Child#1 missed school for about 1 week and is now back attending the facility. Based on all the information provided, LPA Lee observed that although facility was in ratio, a lack of supervision did result in Child#1 in sustaining an injury. Since parents who have the gate code can come into the facility at any time, there should have been a staff member closer to the front entrance. Child#1, ran up to the front door at the very last second before the door has closed. The only way this incident could have been prevented is if a staff member was near the door, or if there was some sort of physical barrier separating the walkway and the outside play area.

The facility was cited during this inspection. Please the attached 809D for further information regarding the deficiency. The citation was cleared during the inspection conducted today since the facility has installed a new gate that separates the walkway leading up to the front door and the outdoor play area. A POC clearance letter was provided to the facility.

The notice of site inspection must remain posted for a period of 30 days during hours of operation. Failure to maintain posting during business hours will result in a civil penalty of $100.00 dollars.

Exit interview conducted with Director Megha Sahni. Appeal rights discussed and explained.
SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Seung Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
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Document Has Been Signed on 09/23/2024 02:00 PM - It Cannot Be Edited


Created By: Seung Lee On 09/23/2024 at 01:42 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: BLOSSOM GARDEN LEARNING ACADEMY
FACILITY NUMBER: 198020970

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2024
Section Cited
CCR
101229(a)(1)

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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). Supervision shall include visual observation. This requirement was not met as evidenced by the following. Child#1 sustained an injury at the facility due to
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The facility has already installed an additional gate on 09/21/24 which separates the walkway leading to the main entrance and the outdoor play area.
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being near the front entrance door which is accessible to children during outside play time. This is a potential 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:Christina Gabelman
LICENSING EVALUATOR NAME:Seung Lee
LICENSING EVALUATOR SIGNATURE:
DATE: 09/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/23/2024


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