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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870549
Report Date: 11/02/2021
Date Signed: 11/02/2021 04:23:50 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:BROOKLYN AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191870549
ADMINISTRATOR:JESSICA ROBLES-LOGANFACILITY TYPE:
850
ADDRESS:329 N. ARIZONA AVETELEPHONE:
(323) 269-4085
CITY:LOS ANGELESSTATE: CAZIP CODE:
90022
CAPACITY:114CENSUS: 39DATE:
11/02/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Jessica Robles-Logan, PrincipalTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Case Management inspection due to an incident that was reported to the Department on October 28, 2021. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Principal, Jessica Robles-Logan who guided LPA on a tour of the facility. Census was taken.

On October 28, 2021 an unusual incident report was made to the department regarding an incident that involved a child who wandered away from staff. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff and the parent of child in question, LPA Garcia determined that child #1 wandered out of the “Orange” classroom and was found outside the entrance/release gate of the patio area by Staff #1.



Although there were four (4) staff who was present providing care and supervision neither observed child #1 leave the “Orange” classroom. One Teacher was assisting a child in the restroom and the other three (3) staff were conducting small group table activity in the classroom. Child #1 was last seen inside the “Orange” classroom by Staff #3 at 10:30 a.m.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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: BROOKLYN AVENUE EARLY EDUCATION CENTER
FACILITY NUMBER: 191870549
VISIT DATE: 11/02/2021
NARRATIVE
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LPA Garcia observed the outdoor gate locked with padlock (pictures were taken) that is located by the patio area where child #1 was found. This gate is currently being used for arrivals and departures of children in care. Child #1 did not exit the premises of the facility. Child #1 was found crying sometime approximately before 10:40 a.m. by Staff #1. Staff interviewed could not account for how this occurred.

Based on information obtained during this investigation and records review during today’s inspection, the following deficiency listed on the attached LIC809 deficiencies page is being cited in accordance with California Code of Regulations, Title 22, Division, 12, Chapter 1, Article 06, Section 101229(a)(1) Care and Supervision.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with facility representative, Jessica Robles-Logan.

END OF REPORT: PAGE 2 OF 2.

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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: BROOKLYN AVENUE EARLY EDUCATION CENTER
FACILITY NUMBER: 191870549
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
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, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement is not met as evidenced by:
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LPAs review of documentation and interviews conducted, staff statements obtained during today’s inspection reveal that child #1 left the “Orange” classroom before being found crying in the entrance/release gate near the patio area of the facility. This poses a potential health and safety risk to children in care.
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In addition, Per Principal she will have an all staff training on care and supervision and will submit training agenda/sign in sheet via email to LPA Garcia no later than 11/15/2021.

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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3