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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570889
Report Date: 06/14/2022
Date Signed: 06/14/2022 11:58:08 AM


Document Has Been Signed on 06/14/2022 11:58 AM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:WILL ROGERS CHILDREN'S CENTERFACILITY NUMBER:
191570889
ADMINISTRATOR:VERONICA BLOOMFIELDFACILITY TYPE:
850
ADDRESS:11250 DUNCANTELEPHONE:
(310) 603-1544
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:71CENSUS: 34DATE:
06/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Alida Garcilazzo & Dr. Veronica Bloomfield TIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rita Ramos conducted an unannounced case management inspection on 06/14/22 due to an incident that occurred at the facility on 05/27/22. LPA met with Alida Garcilazzo, Site Facilitator, who guided LPA on a tour of the facility. There were 34 children and 7 staff present upon arrival. LPA was later met by Dr. Veronica Bloomfield, Program Director.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on 05/27/22, was reported to the Department on 06/02/22, via fax. The facility did not report the Unusual Incident to the Department within the required 24 hours of occurrence. LPA informed Program Director, that although the incident occurred on Friday 05/27/22, and the school was closed 05/30/22 in recognition of Memorial Day, the facility should have reported the incident by 05/31/22 which would be the next business day.

Information reported to the Department indicated that Child #1 sustained an injury that required medical attention. .

Based upon information received from the interviews conducted and documentation obtained, it was determined that Staff #3 was out of ratio when Child #1 sustained the injury which poses an immediate health and safety risk to children in care. Per Program Director and Site Facilitator, this facility is a Title 5 program. Title 5 programs that are funded by the Department of Education are required to maintain a 1:8 teacher child ratio at all times. Documentation provided to LPA indicates that Staff #3 was singularly caring for 9 to 10 children at the time of the incident. ----------Page 1 of 2

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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 4


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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: WILL ROGERS CHILDREN'S CENTER
FACILITY NUMBER: 191570889
VISIT DATE: 06/14/2022
NARRATIVE
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The following deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Dr. Veronica Bloomfield, Program DIrector, including, but not limited to Provider Rights, Appeal Procedures

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided during this visit.

---Page 2 of 2

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/14/2022 11:58 AM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: WILL ROGERS CHILDREN'S CENTER
FACILITY NUMBER: 191570889

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2022
Section Cited

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Teacher-Child Ratio
Child development programs funded by the California Department of Education and operating under Title 5...Contractors shall maintain at least the following minimum ratios in all centers: Preschool (36 months to enrollment in kindergarten) - 1:8 adult-child ratio, 1:24 teacher-child ratio.
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This requirment is not met as evidenced that Staff #3 was singularly caring for 9 to 10 children at the time that Child #1 sustained an injury that required medical atteniton. This poses an immediate health and safety risk to children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4


Document Has Been Signed on 06/14/2022 11:58 AM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: WILL ROGERS CHILDREN'S CENTER
FACILITY NUMBER: 191570889

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/21/2022
Section Cited

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Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.

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This requirement is not met as evidenced by facility failing to report the incident within 24 hours of occurence or within the next working day which poses a potential health and safety risk to children in care.
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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: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Rita RamosTELEPHONE: (323) 981-3985
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4