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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806530
Report Date: 02/21/2020
Date Signed: 02/21/2020 12:40:08 PM

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:CHILDREN'S HOSPITAL INFANT CARE CENTERFACILITY NUMBER:
191806530
ADMINISTRATOR:LAURA HERNANDEZFACILITY TYPE:
830
ADDRESS:4601 SUNSET BOULEVARDTELEPHONE:
(323) 361-4601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY:27CENSUS: 18DATE:
02/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Birrueta, Site SupervisorTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Janeth Chavez conducted an unannounced case management inspection due to an incident that occurred on 08/20/2019. LPA met with Veronica Montano Sanchez, Site Supervisor who guided LPA on a tour of the facility. There are 18 infants present with 8 staff. LPA conducted interviews with staff during this visit.

The incident that occurred on 08/20/2019 and was reported to the Department on 08/22/2019, via telephone. The facility became aware of the incident on 08/21/2019 and reported the Unusual Incident to the Department within the required 24 hours of occurrence. Information reported to the Department indicated that Child #1 was left alone in the napping area for about 45 minutes. Based upon incident report and the staff interviewed, it was determined that Child #1 was left unsupervised in the napping area for about 45 minutes by Staff #1 & #2 and was reported to the Director by Staff #3. As per Site Supervisor Staff #1 is no longer employed at this facility as of 10/01/2019 and Staff #2 was placed on administrative leave. No child shall be left alone without the visual supervision of a teacher at any time. This is a potential risk to the health and safety of children in care.

The following deficiency listed on the attached LIC 809 D is being cited in accordance with California Code of Regulations Title 22.

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 Maria Birrueta, Site Supervisor, including, but not limited to Provider Rights, Appeal Procedures.

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDREN'S HOSPITAL INFANT CARE CENTER
FACILITY NUMBER: 191806530
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2020
Section Cited

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Responsibility for Providing Care and Supervision

No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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This requirement is not met as evidenced by Staff #3 disclosing that on 08/20/19 Child #1 was left unsupervised in the napping area for about 45 minutes by Staff #1 & #2. This is 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: Claudia GuangorenaTELEPHONE: (323) -98-3417
LICENSING EVALUATOR NAME: Janeth ChavezTELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2020
LIC809 (FAS) - (06/04)
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