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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021205
Report Date: 05/13/2024
Date Signed: 05/13/2024 03:28:37 PM

Document Has Been Signed on 05/13/2024 03:28 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:HART PRESCHOOLFACILITY NUMBER:
198021205
ADMINISTRATOR/
DIRECTOR:		MONIQUE ORNELASFACILITY TYPE:
850
ADDRESS:859 S. RAYMOND AVE.TELEPHONE:
(213) 422-2176
CITY:PASADENASTATE: CAZIP CODE:
91105
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 29DATE:
05/13/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:16 PM
MET WITH:Monique Ornelas TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shushanik Safaryan conducted an unannounced Case Management Inspection to the above facility . Upon arrival LPA met with the Facility Representative Monique Ornelas who guided LPA on a tour of the facility . During the visit LPA observed 29 children with 4 staff members .

Per section 101212 Reporting Requirements , licensee shall notify the Department upon the occurrence , during operation of the childcare center of any events specified in (d) (1) below, and reports shall be made to the Department by telephone or fax within the Department`s next working day and during its normal hours . In addition, a written report containing the information specified shall be submitted to the Department within seven days following the occurrence of such event .
On 03/01/2024 Child was found unattended in the class by the staff member . Written report was received by the Department on 04/24/2024 by email . Facility did not report this incident in the required time frame indicated in section 101212 (d) ,which poses/posed a potential health, safety, or personal rights risk to persons in care.
Based on the information obtained the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22.
Deficiencies that are being cited need to be cleared to protect the children’s health & safety.
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of
$100.00
An exit interview was conducted, and a copy of this report was provided and explained to Facility Representative , Monique Ornelas along with Appeal Rights.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2024
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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Document Has Been Signed on 05/13/2024 03:28 PM - It Cannot Be Edited


Created By: Shushanik Safaryan On 05/13/2024 at 03:19 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: HART PRESCHOOL
FACILITY NUMBER: 198021205

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2024
Section Cited
CCR
101212

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101212Reporting Requirements d)Upon...occurrence.. any... events specified..below, report shall be made ... by telephone...fax within the.. next working day and during... business hours...(1)Events reported..(C)Any unusual incident..This requirement is not met evidenced by
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Per Facility Representative staff will review reporting requirements and Director will send statement of acknowledgement to the LPA by POC date .
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Based on the information obtained Facility did not report unusual incident occurred on 03/01/2023 on time , which poses/posed a potential health, safety, or personal rights risk to persons 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Shushanik Safaryan
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024


LIC809 (FAS) - (06/04)
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