Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417385
Report Date: 04/12/2017
Date Signed 04/13/2017 08:10:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:DEVONSHIRE PRESCHOOL AND INFANT CENTERFACILITY NUMBER:
197417385
ADMINISTRATOR:LORELL BATTERWORTHFACILITY TYPE:
830
ADDRESS:21203 DEVONSHIRE STREETTELEPHONE:
(818) 700-2821
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:43CENSUS: 26DATE:
04/12/2017
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:31 PM
MET WITH:Lorell BatterworthTIME COMPLETED:
04:15 PM
NARRATIVE
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A case management visit was conducted by Licensing Program Analysts (LPA) Margarit Sislyan. LPA met with Lorell Batterworth (Director).

LPA was notified that the facility had 10 cases of Head, Foot, and Mouth Disease.
The facility failed to report the epidemic outbreak to the department.

An exit interview was conducted and a copy of this report was provided
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2017
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, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME: DEVONSHIRE PRESCHOOL AND INFANT CENTER
FACILITY NUMBER: 197417385
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/12/2017
Section Cited
101212(d)
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Reporting Requirements. A report shall be made to the Department within 24 hours of the occurrence of any unusual incident as specified. (E) Epidemic outbreaks (Head, Foot, and Mouth Disease).
The facility failed to report the epidemic outbreak to the department.
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Licensee shall report the unusual incident to CCLD within 24 hours.

POC date 04/12/17
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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: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (310) 337-4346
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2017
LIC809 (FAS) - (06/04)
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