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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570644
Report Date: 11/09/2021
Date Signed: 11/09/2021 11:47:02 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:EAST LA COLLEGE CAMPUS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191570644
ADMINISTRATOR:SIMONE, MICHAELFACILITY TYPE:
850
ADDRESS:1301 AVENIDA CESAR CHAVEZTELEPHONE:
(323) 265-8717
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:180CENSUS: 44DATE:
11/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Marcia Cagigas, Director and Mia Castro, Lead TeacherTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Lilli Babcock and Mireya Garcia conducted an unannounced Case Management inspection due to an incident that was reported to the Department on November 03, 2021. Due to COVID-19, precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPAs met with Director, Marcia Cagigas who guided LPAs on a tour of the facility. Census was taken.

On November 03, 2021 an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that required medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff, LPAs Babcock & Garcia determined that during outdoor play, child fell and hit their forehead on the metal pole that is connected to the climbing structure. Although staff was present and observed the incident, staff could not reach the child in time to prevent fall. At approximately 8:43 a.m., during this inspection LPAs did not observe any tripping hazards near or on the area where incident took place. Child was taken to the hospital and head injury was glued back together. Child has not returned to day care.


REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
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: EAST LA COLLEGE CAMPUS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 191570644
VISIT DATE: 11/09/2021
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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. The facility followed all proper procedures; Staff administered first aid, child’s parent was notified, incident report was sent in properly and timely and all medical needs were met. Per Director, soft cushioning will be placed on pole to help prevent future injury. Per staff, children will be reminded of the safety rules. In addition, staff will model for children how to safely release themselves from arched monkey bar portion of the structure to prevent falls in the future.


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


Exit interview conducted and report was reviewed with the facility representative, Mia Castro.


END OF REPORT: PAGE 2 OF 2.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Lilli BabcockTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2