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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300613949
Report Date: 08/23/2022
Date Signed: 08/23/2022 03:27:55 PM

Document Has Been Signed on 08/23/2022 03:27 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:ABC DEVELOPMENT PRESCHOOL #1FACILITY NUMBER:
300613949
ADMINISTRATOR:MARY HEINFACILITY TYPE:
840
ADDRESS:4631 1/2 LA PALMA AVE.TELEPHONE:
(562) 924-1508
CITY:LA PALMASTATE: CAZIP CODE:
90623
CAPACITY: 42TOTAL ENROLLED CHILDREN: 28CENSUS: 23DATE:
08/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Valerie Mora, Director TIME COMPLETED:
03:40 PM
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On 08/23/2022 Licensing Program Analyst (LPA), Stella Gutierrez made an announced visit to the facility for the purpose of a self reported incident that was received on 08/12/2022. LPA, Gutierrez was met by Valerie Mora, Director who was explained the reason for today's visit. LPA, Gutierrez did not observed any children upon arrival until the facility started operation that starts at 2:35 PM. LPA observed 23 children ages (5-12) , LPA, Gutierrez observed Director and 2 other staff at the facility for the school age license. Facility is dual licensed and operated a preschool program in the same building. Facility has three rooms. Middle classroom is opening where the children are combined from 6:30 AM-7:30 AM and then closing 5:00 PM - 6:00 PM. Facility has a restroom waiver on file to have a shared restroom with the preschool (Steve Luther Elementary) During the summer months there the program is operated as an all day program
A review of the Facility Personnel Report Summary conducted on 08/23/2022 indicates all facility staff or other individuals who required caregiver background checks have received criminal record and child abuse index clearances or exemptions

The self reported incident reported by the facility alleges that there was inappropriate interaction between a two children at the facility. LPA, Gutierrez interviewed 03 staff and 02 children during today's inspection.

Based on the information received the facility the facility is a licensed school age day-care and the two children in question were both considered school age while attending the facility's summer camp program. The inappropriate interaction was investigated and there were no disclosures from the statements that were provided by staff or children to prove the alleged incident occurred. LPA, Gutierrez obtained a copy of the summer camp facility children's roster (LIC 9040) during to day's visit. There will be no citations issued during today's visit.

An exit interview was conducted with Valerie Mora, Director. A copy of this report, notice of site visit (to be posted no less than 30 days) and applicant/appeal rights were provided to Director. Page 1 of 1
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Stella Gutierrez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2022
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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