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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870647
Report Date: 05/03/2022
Date Signed: 05/03/2022 03:58:22 PM


Document Has Been Signed on 05/03/2022 03:58 PM - It Cannot Be Edited

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 IRINEOFACILITY TYPE:
850
ADDRESS:3142 LYDIA DRIVETELEPHONE:
(323) 268-9868
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:184CENSUS: 18DATE:
05/03/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Elizabeth Irineo, Facility RepresentativeTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection on 5/3/22 at 3:00 PM. Upon arrival, LPA met with Elizabeth Irineo, Facility Representative (FR). There were 16 children present during inspection.

On 3/10/2022, FR submitted an unusual incident report to the Department. The unusual incident stated that a child was unattended in a classroom. LPA conducted interviews, inspected the outdoor area and classrooms and reviewed documentation regarding the incident. Information received was that C1 was playing outside being supervised by S1. S1 turned around to put toys away and when they looked back they did not see C1. In the time it took for S1 to make other staff aware of the incident and begin looking for C1, the child was being brought back outside by FR. Per interviews the child was inside for less than two minutes without supervision, which is a violation of Title 22. Per FR C1 is a new child and they are working on behaviors.

During initial inspection the facility had already implemented safeguards so the incident would not happen again. LPA observed a child safety gate put up inside the classroom. A safety gate was put up outside blocking a blind spot. The doors leading into the classroom's are now locked and shut when children are playing outside. Teacher's have a key to unlock doors. A teacher is assigned to supervise C1 at all times. The parent of C1 was notified and is working with staff on behavior. Teachers are now counting the children when they transition to any area.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business --------------------PAGE 1

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: DACOTAH STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870647
VISIT DATE: 05/03/2022
NARRATIVE
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day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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

Exit interview conducted and report was reviewed with the Facility Representative, Elizabeth Irineo.

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/03/2022 03:58 PM - It Cannot Be Edited

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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: DACOTAH STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191870647

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/04/2022
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...
This requirement was not met as evidenced by:
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Based on observation/interview/record review facility representative did not ensure C1 was supervised at all times. This poses an immediate Health, Safety, or Personal Rights 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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2022
LIC809 (FAS) - (06/04)
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