Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670506
Report Date: 11/15/2016
Date Signed 11/16/2016 08:03:06 AM

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:ARTESIA HIGH SCHOOL CHILDREN'S CENTERFACILITY NUMBER:
191670506
ADMINISTRATOR:ARLENE RIDDICKFACILITY TYPE:
850
ADDRESS:20651 NORWALK BLVDTELEPHONE:
(562) 229-7959
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY:104CENSUS: 30DATE:
11/15/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Arlene RiddickTIME COMPLETED:
12:00 PM
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LPA, S. Robinson-Horn conducted a Case Management visit to obtain additional information on an incident that occurred on 10.31.16. Upon arrival LPA met with Site Supervisor, Arleene Riddick and informed her of the nature of the visit.

Information reported to the Department indicated on 10.31.16 a parent informed Site Supervisor, Arleene Riddick their child had received a pow pow from a new teacher at the facility during lunch time.

During today’s visit interviews were conducted with Site Supervisor, Teacher and a child in care. The LPA also obtained and documented information from a child's file.

There are no violations of Title 22 Regulations being cited at this time. The information received from the interviews conducted did not support the information disclosed by the parent. However LPA will attempt to make contact the parent to obtain additional information.

Notice of Site Visit must be posted for 30 days. Failure to post required Notice for 30 consecutive days will result in immediate civil penalty assessment of $100. Licensee is aware that all reports must be made available to the public for the next 3 years.

Web site address to order forms: www.ccld.ca.gov – To access licensing forms, updates and Title 22. Exit interview was conducted on this date with Site Director, Arleene Riddick

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Shameka Robinson-HornTELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2016
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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