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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870647
Report Date: 05/23/2019
Date Signed: 05/23/2019 11:00:47 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:DACOTAH STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870647
ADMINISTRATOR:ELIZABETH MARESFACILITY TYPE:
850
ADDRESS:3142 LYDIA DRIVETELEPHONE:
(323) 268-9868
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:184CENSUS: 107DATE:
05/23/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lead TeacherTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility for the purpose of conducting a case management incident inspection that was self-reported on 05/16/19. The department had received the written report on 5/16/19 regards a child had notified his teacher that he swallowed the tip of the zipper that was detached from his jacket. Upon arrival, LPA met with center staff. Per staff stated, Principal and designee teacher are both currently not available. Lead teacher will be representing the facility in their absence. LPA observed proper care and supervision.

LPA completed children and staff records review. LPA had obtained personnel report, daily sign in/out, and child's document. Based on the available information that were gathered during today's inspection, it reveals that on 5/16/19 around 8:00AM there were 31 children with one teacher and four teacher assistants. C1 was never left alone unsupervised by center staff. When C1 notified his teacher that he had swallowed the tip of the zipper. Teacher immediately followed the health and safety protocol to ensure child is safe. Parent was contacted and C1 had been seen by a doctor. C1 was fine, no harm was done, and was able to return to school the next day. The facility was in compliance with Title 22 Regulations for care and supervision. No deficiency was cited.

An exit interview was conducted. The copy of this report was provided to the noted person.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2019
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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