191595072-10-23-2026-33-CC-DORZ-DZ5U6K-20261023151827

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191595072
Report Date: 10/23/2026
Date Signed: 10/23/2026 03:18:47 PM

Document Has Been Signed on 10/23/2026 03:18 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:	CLAREMONT UNITED CHURCH OF CHRIST, EARLY CHILDHOOD		FACILITY NUMBER:	191595072
ADMINISTRATOR/ DIRECTOR:	KNIGHT, KRISTY		FACILITY TYPE:	830
ADDRESS:	233 W. HARRISON		TELEPHONE:	(909) 624-2916
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY: 32	TOTAL ENROLLED CHILDREN: 32	CENSUS: 26	DATE:	10/23/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Director, Kristy Knight		TIME VISIT/ INSPECTION COMPLETED:	03:30 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

On 10/23/26, Licensing Program Analyst (LPA) Diana Ortiz conducted an unannounced Case Management-Incident Report visit. LPA met with Director Kristy Knight who was informed the purpose of this visit. LPA was guided on a tour of the facility. LPA observed 26 infant/toddlers and 11 staff present during this visit. Per Director, there are currently 32 infant/toddlers enrolled and are on staggered schedules. The department received an unusual incident report on 10/16/26 via telephone call for an incident that occurred on 10/14/26. Written report was received via email on 10/21/26. Per Title 22 Regulations the incident was reported in a timely manner.

On 10/16/26, an incident was self-reported to the Department. According to the incident report, Child #1 (C1) reportedly ingested lentils while participating in a sensory activity in the infant classroom, Little Sprouts, on 10/14/26.

During today’s inspection, LPA conducted interviews with the Director and three (3) staff members regarding the incident. LPA obtained and reviewed documentation relevant to the incident, including email correspondence between C1’s parents and the Director, the facility’s in-house incident report titled “This Is What Happened Today,” documentation of updated classroom protocols distributed to staff, and written staff statements regarding the incident. LPA reviewed staff personnel files to verify that all staff present had current CPR certifications and reviewed C1’s file. LPA attempted to contact C1’s parents to conduct interviews but was unsuccessful.

Director reported that at approximately 3:50 p.m. on 10/14/26, Staff #1 (S1) brought C1 to the office after C1 reportedly placed lentils in the mouth, began coughing, and appeared to be chewing. Director stated that C1 appeared congested but was not visibly in distress.

Page 1 of 3

Brandi VanOosten
Diana Ortiz
	DATE: 10/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2026

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 5

California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

Page: 2 of 5

Document Has Been Signed on 10/23/2026 03:18 PM - It Cannot Be Edited

Created By: Diana Ortiz On 10/23/2026 at 01:42 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: CLAREMONT UNITED CHURCH OF CHRIST, EARLY CHILDHOOD	FACILITY NUMBER: 191595072
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/23/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/23/2026 Section Cited CCR 101223(a)(2)	1 2 3 4 5 6 7	101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This regulation was not met as evidence by:	1 2 3 4 5 6 7	Per Director, lentils and similar small materials were removed from the facility. Updated classroom protocols were distributed to all staff. Additionally, staff will have training on procedures for suspected ingested and choking hazards.
	8 9 10 11 12 13 14	On 10/14/26, dry lentils were accessible to a 10 month infant during a sensory activity, creating a potential ingestion or choking hazard.	8 9 10 11 12 13 14
	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.

	Brandi VanOosten
NAME OF LICENSING PROGRAM MANAGER:

	Diana Ortiz
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/23/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2026

LIC809 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CLAREMONT UNITED CHURCH OF CHRIST, EARLY CHILDHOOD	FACILITY NUMBER: 191595072
	VISIT DATE: 10/23/2026

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
26
27
28
29
30
31
32

At approximately 3:54pm, Director instructed S1 to notify C1’s mother, who arrived at approximately 4:30 p.m. C1s parent was then taken to the infant classroom where the incident occurred and then parent left with C1. On 10/16/26, Director received an email from C1’s parent stating that C1 had been hospitalized in the ICU since the incident date of 10/14/26, due to reportedly aspirating one or more lentils into the lungs. Medical documentation is pending.

Staff #1 (S1) reported supervising three (3) infants participating in a sensory activity at the sensory table on 10/14/26. S1 stated that they observed Child #1 (C1) place lentils in the mouth. S1 immediately wiped C1’s mouth, and patted C1’s back as a precaution when C1 began coughing and crying. S1 brought C1 to the Director and contacted C1’s mother, who arrived at approximately 4:30 p.m. and was informed of the possible ingestion and advised to seek medical evaluation due to the lingering cough infant already had and also the possibility of ingesting lentils.

Staff #2 (S2) reported assisting other infants near the diaper-changing area when S2 observed S1 supervising C1 and two (2) other infants during the sensory activity. S2 stated that S2 informed S1 that C1 appeared to be chewing, after which C1 began coughing more forcefully than usual. S2 did not observe C1 place lentils in the mouth. S2 acknowledged that lentils should not have been used in the infant sensory area.

Staff #3 (S3) reported being approximately two feet away from the sensory area but did not observe C1 place lentils in the mouth. S3 stated that S1 cleaned C1’s mouth after suspecting possible ingestion and that C1 subsequently began coughing and crying. All staff stated that C1 had been congested and coughing for approximately one and a half weeks before the incident.

Based on the LPA’s observations, records reviews and interviews, 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 and safety.

LPA Diana Ortiz informed facility representative Kristy Knight that this report dated 10/23/26 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Page 2 of 3

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2026

LIC809 (FAS) - (06/04)

Page: 4 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: CLAREMONT UNITED CHURCH OF CHRIST, EARLY CHILDHOOD	FACILITY NUMBER: 191595072
	VISIT DATE: 10/23/2026

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
26
27
28
29
30
31
32

Also, LPA informed the facility representative to provide a copy of this licensing report dated 10/23/26 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director, Kristy Knight.

Page 3 of 3

NAME OF LICENSING PROGRAM MANAGER: Brandi VanOosten
NAME OF LICENSING PROGRAM ANALYST: Diana Ortiz
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/23/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2026

LIC809 (FAS) - (06/04)

Page: 5 of 5