Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018022
Report Date: 06/05/2015 12:00:00 AM
Date Signed 06/05/2015 02:47:16 PM

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:LEARN, PLAY AND GROWFACILITY NUMBER:
198018022
ADMINISTRATOR:HALLADJIAN, VIRGINEFACILITY TYPE:
850
ADDRESS:1000 E. ROUTE 66 #DTELEPHONE:
(626) 750-3272
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:45CENSUS: 2DATE:
06/05/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Virgine HalladjianTIME COMPLETED:
02:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Cynthia Reyes, Licensing Program Analyst, (LPA) conducted an unannounced Case Management-Incident report visit. There was one (1) Incident report that came into the office on 05/14/15.

LPA Met with Director Virgine Halladjian, who guided the analyst on a tour of the facility. LPA interviewed, reviewed and received records. LPA went over Incident report with Ms. Valladjian.

Based on information obtained on this date, no follow up is necessary regarding the incident report listed above. The facility followed all proper procedures per the parent hand book/admission agreement, incident was called in and report was sent in properly and timely, all medical needs were met if needed and parents notified.

Incident is found to be Substantiated. See 809 D for citation.

Exit interview conducted and a copy of this report was left with Director Virgine Halladjian .
No Citation was given at this time.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2015
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: LEARN, PLAY AND GROW
FACILITY NUMBER: 198018022
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2015
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2015
Section Cited
101229(a)(1)
1
2
3
4
5
6
7
CARE AND SUPERVISION
No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1).
Boy child bite girl child on the arm, staff did not witness the Incident.
1
2
3
4
5
6
7
Director states she will speak with the staff and write the department a letter on how she will ensure this does not happen again.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Cynthia ReyesTELEPHONE: (323) 981-3369
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2015
LIC809 (FAS) - (06/04)
Page: 2 of 2