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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610280
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:09:28 PM


Document Has Been Signed on 10/12/2022 12:09 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:FERNALD CHILD CARE CENTERFACILITY NUMBER:
191610280
ADMINISTRATOR:ALICIA MINOR BROWNFACILITY TYPE:
850
ADDRESS:320 CHARLES YOUNG DRIVE NORTHTELEPHONE:
3108252900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY:36CENSUS: 32DATE:
10/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Arpine Panosyan, Coordinator - Designated of ResponsabilityTIME COMPLETED:
12:12 PM
NARRATIVE
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On 10/12/2022, 8:25AM Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced case management inspection to the facility to follow up
on the self reported unusual incident that occurred on 09/01/2022. LPA observed 32 children being supervised by 4 staff and Coordinator. LPA met with Arpine Panosyan, Coordinator, designated of Facility Responsibility and informed the purpose of the visit. Director was not present during this visit.

According to the incident report received, on 09/01/2022, child#1 left without supervision at the playhouse area, approximately for 10-12minutes. Staff#1 found the child#1 inside of the playhouse at the big yard and Staff#2 brought the Child#1 to the Director's office.

LPA obtained a copy of Child Care Facility Roster, sign in and out dated 09/01/2022, declaration from staff, time card for the staff that were present when the incident happened. LPA reviewed the Staff files that were involved on this incident. LPA conducted interviews with the staff, child's parent and attempted to interview child#1.

Based on the information obtained throughout the course of the investigation which include interviews with facility staff, parent of the child#1 and attempt to interview child#1, observations at the facility and review of records, it was revealed that on 09/01/2022, child #1 was left at the big yard at playhouse without supervision. Child
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: FERNALD CHILD CARE CENTER
FACILITY NUMBER: 191610280
VISIT DATE: 10/12/2022
NARRATIVE
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was brought to the classroom 10-12minutes later and staff were not aware that child#1 was left alone at the big yard at the playhouse.
The facility is cited a Type A citation in violation of Title 22 CCR Title 22, Division 12 Chapter 1 Article 06. Continuing Requirements 101229 Responsibility for Providing Care and Supervision. (See LIC 809-D for deficiency cited).

LPA explained that the deficiency was Type A violation and required immediate correction. Coordinator was further informed of AB633 requirements. Coordinator was provided for LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled and to obtain the parent's signature on form LIC9224, as acknowledgement that they received a copy of this report. Form LIC9224 is to be retained in the child's file.

Coordinator was further instructed to complete this same process for all children who enroll in the facility within 12 months of this report date..

A copy of this report, Notice of Site Visit, Appeals Rights were provided to Arpine Panosyan, Coordinator, Designated of Facility Responsibility.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/12/2022 12:09 PM - 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: FERNALD CHILD CARE CENTER
FACILITY NUMBER: 191610280

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2022
Section Cited

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101229 Responsibility for Providing Care and Supervision.
(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time,..Supervision shall include visual observation.
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This requirement is not met as evidenced by: On 9/1/2022 child #1 was left at the big yard at playhouse without supervision. Child#1 was brought to the classroom 10-12minutes later and Staff were not aware that child#1 was left alone at the big yard at the playhouse.This is a Type A citation and poses a immediately health and safety risk to children in care.

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Coordinator was further instructed to complete this same process for all children who enroll in the facility within 12 months of this report date and maintain copy of lic9924 on children's file.

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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: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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