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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670678
Report Date: 06/18/2019
Date Signed: 06/18/2019 02:25:53 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CULVER CITY CHILDREN'S CENTERFACILITY NUMBER:
191670678
ADMINISTRATOR:AUDREY STEPHENSFACILITY TYPE:
850
ADDRESS:10800 FARRAGUTTELEPHONE:
3108424230
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:56CENSUS: 42DATE:
06/18/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Vanessa San Martin, Assistant DirectorTIME COMPLETED:
02:21 PM
NARRATIVE
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On 6/18/20-19 at 1:01pm, Licensing Program Analyst LPA Miranda conducted an unannounced case management – deficiency visit and delivered the finding complaint received on 4/22/2019. During complaint investigation for complaint control #30-CC-30-CC-20190422130244,it was revealed the following deficiencies:
  • Physical environment
  • Reporting requirement

The facility was cited a type B deficiency. Please see Facility Evaluation Report LIC 809D for deficiency cited.
LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

Upon receipt of this report, the report must be posted along with the notice of site visit for 30 days for parents to view.


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. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted with Assistant Director, a copy of this report was provided along with the Notice of Site Visit and the Appeal Rights.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CULVER CITY CHILDREN'S CENTER
FACILITY NUMBER: 191670678
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/18/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2019
Section Cited
CCR
101238.3.b
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Indoor Activity Space: (b) The floors of all rooms shall have a surface that is safe and clean. This requirement is not met as evidenced by: During the interviews with current parties and observations it was revealed that was a common practice children had access to turn on/off the light
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On 6/18/19 Assistant Dkirector provided a document signed for all staff informing the children in care are not allow to switch the light on/off. Also, LPA observed classrom#2 dramatic area, there are no gaps between cubbies/shelves.
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and the shelves on the classroom#2. Also, the position of the shelves in the classroom#2 at the dramatic area was not showing teacher did not have full vision observation. This is an potential health and safety risk to children in care.

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Type B
06/19/2019
Section Cited
CCR
101212.d
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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. In addition, a written
report containing the information specified
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Director agreed send no later than tomorrow the unusual incident report LIC624 no later than 6/19/19. Director assistant will be training the teacher/staff regarding the reporting requirement procedures, a copy of the training and agenda will send to LPA Miranda no later than 6/19/2019
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in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Facility
did not report to RO two incidents: 1) on 1/17/19, a child sustained a injured and 2) on 3/29/19 a child touched inappropriate to another child.
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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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
LIC809 (FAS) - (06/04)
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