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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570895
Report Date: 09/19/2023
Date Signed: 09/19/2023 10:36:47 AM


Document Has Been Signed on 09/19/2023 10:36 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LINDBERGH FULL DAYFACILITY NUMBER:
191570895
ADMINISTRATOR:VERONICA BLOOMFIELDFACILITY TYPE:
850
ADDRESS:12120 LINDBERGH ROADTELEPHONE:
(310) 631-7308
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:73CENSUS: DATE:
09/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Gisele Ochoa, Program SpecialistTIME COMPLETED:
10:45 AM
NARRATIVE
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On 09/19/2023 at 9:12 AM Licensing Program Analysts (LPAs) Katrina Chicote and Angelica Wallin conducted an Unannounced Case Management Inspection to follow up on an incident that was reported to the Department on 09/11/2023. Upon arrival, LPAs announced purpose of visit and met with Gisele Ochoa, Program Specialist, who reported the incident to The Department.

On 09/11/2023, an incident was reported to the department where a child was left unattended in Multi-Purpose Room for 5 to 15 minutes. Per Reporting Party, the child was found by another staff member who entered the Multi-Purpose Room for their break. The facility reported this incident to The Department within the required 24 hours and written report submitted within seven days.

During this inspection LPAs interviewed Teacher named on the report to discuss the incident and follow up conducted by Administrators. Teacher discussed supervision protocols as well as information obtained from training videos that was watched as a result of incident taking place. Per Teacher, she has been provided training via CCLD's website on Supervision, Health and Safety Training, Teacher-to-Child Ratios in Child Care Centers, and Locks and Inaccessibility Requirements in Child Care. LPAs observed the Multi-Purpose Room where incident took place. LPAs observed Multi-Purpose room to have child size tables and chairs and shelves with child appropriate toys available. LPAs observed Multi-Purpose Room to have access to Staff Break Area that is partitioned off and access to Kitchen. LPAs observed both these areas and did not observe any hazards at time of inspection. LPAs obtained and reviewed documentation provided by Program Specialist, which includes copy of child-ratio counts conducted by staff, email that was sent out to staff with the above videos mentioned, and Professional Development specific to Teacher named on report with signatures corroborating information provided by Teacher dated on 09/13/2023 that she watched videos. Based on the information obtained and LPAs observation, LPAs determined due to child being left completely unattended for a period of 5 to 15 minutes there was not adequate supervision provided the day of the incident.
Report Continues - Page 1 of 2
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023
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 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895
VISIT DATE: 09/19/2023
NARRATIVE
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Based on this information, the following deficiencies on the attached LIC 809D 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 & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Program Specialist, Gisele Ochoa.


Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 09/19/2023 10:36 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/20/2023
Section Cited
CCR
101229(a)(1)

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101229 (a)(1) Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time,...shall include visual observation.
This regulation was not met as evidenced by:
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Facility Representatives states that staff, including Teacher named on report, has completed Professional Development training in regards to supervision and ratios via Department website videos. LPAs obtained signatures confirming training completion. Clearing deficiency on this date.
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Based on LPAs observations and interviews, Licensee did not have full supervision, including visual supervision, of a child for a period of 5 to 15 minutes. This poses an immediate health, safety, and personal rights 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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3