<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806104
Report Date: 02/11/2020
Date Signed: 02/11/2020 10:54:26 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:DOLORES MISSION WOMEN'S COOPERATIVE CHILD CARE CTRFACILITY NUMBER:
191806104
ADMINISTRATOR:DIANA RAMIREZFACILITY TYPE:
850
ADDRESS:157 S. GLESS ST.TELEPHONE:
(323) 881-0010
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:30CENSUS: 21DATE:
02/11/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Cecilia Luna Perez TIME COMPLETED:
11:10 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Case Management inspection on this day. Met with Teacher Cecilia Luna Perez. Facility Director, Morena Duran was not present at the time of arrival but arrived at approximately 9:45 AM. The purpose of this visit was to ensure that the facility is in compliance with Title 22 regulations.

Upon arrival, LPA observed 20 children with 03 staff. Staff names were recorded. LPA observed that Teacher, Cecilia Luna Perez, is not associated to the facility and has been working since September 2019. This poses an immediate risk to the health and safety of children in care. A civil penalty of $500 is being assessed.

LPA requested a children's roster and a roster was not available. LPA requested to view children's records and children's records were not available at the facility.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care and any newly enrolled children for up to one year.
A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

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. Exit interview was conducted with Rosalie Reyes. Appeal Rights and Procedures explained and provided.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: DOLORES MISSION WOMEN'S COOPERATIVE CHILD CARE CTR
FACILITY NUMBER: 191806104
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

1
2
3
4
5
6
7
Child's Records
A separate, complete and current record for each child is maintained in the child care center.
This requirement was not met as evidenced by LPA requesting to view children's records. There were no records available to view. This is a potential risk to the health and safety of children in care.
Type B
02/21/2020
Section Cited

1
2
3
4
5
6
7
Current roster of children provided care in facility required
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and
8
9
10
11
12
13
14
telephone number of the child's physician. This roster shall be available to the licensing agency upon request.
This requirement was not met as evidenced by request of facility roster. A roster was not available. This is a potential risk to the helath and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 2 of 3
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: DOLORES MISSION WOMEN'S COOPERATIVE CHILD CARE CTR
FACILITY NUMBER: 191806104
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2020
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
Request a transfer of a criminal record clearance.
8
9
10
11
12
13
14
This requirement was not met as evidenced by criminal record clearance association list. Teacher Cecilia Luna Perez is not associated to the facility and has been working at the facility since September 2019. This is an immidiate risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 3 of 3