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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870647
Report Date: 12/07/2023
Date Signed: 12/07/2023 03:23:45 PM


Document Has Been Signed on 12/07/2023 03:23 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:DACOTAH STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870647
ADMINISTRATOR:SHAMIKA ROBINSON-HORNFACILITY TYPE:
850
ADDRESS:3142 LYDIA DRIVETELEPHONE:
(323) 268-9868
CITY:LOS ANGELESSTATE: CAZIP CODE:
90023
CAPACITY:184CENSUS: DATE:
12/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Iliana Carrasco, TeacherTIME COMPLETED:
03:40 PM
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
On 12/07/2023 at 2:05 PM, Licensing Program Analyst (LPA) Katrina Chicote conducted an Unannounced Case Management - Incident inspection to the above facility for the purpose of following up on an incident that was reported to the Department on 10/12/2023. Upon arrival, LPA announced purpose of inspection and was granted entry to facility by Office Staff. LPA initially met with Facility Representative (FR), Iliana Carrasco. Principal Shameka Robinson-Horn was not present during today's inspection.

On 10/12/2023, an incident was reported to The Department where a child sustained an injury while in care that required medical attention. The facility reported this incident to the Department within the required 24 hours and submitted a written report via email within seven days. Per report, staff observed incident occur and administered first aid immediately. Parent was notified via "Notice of First Aid" which was signed by the parent and child continued with daily activities only to be picked up at at the end of the day. Facility later received a phone call from parent that child was taken to hospital where it was discovered child suffered a hairline fracture.

During this inspection, LPA interviewed Facility Representative in regards to incident who stated that long term sub named on the report witnessed the incident but is not present during today's inspection but can confirm that incident was observed. LPA observed outdoor play area where incident took place, surface of playground is bumpy and per FR there are already plans to repave but it is a timely process. FR states they do constantly remind students of where they are walking and to be mindful of the surface. Per FR, child did return after a couple of days with a cast and doctor's orders to not have extrenuous exercise. LPA observed child was present during today's inspection and cast has already been removed.

Per California Code of Regulations Title 22, Division 12, no deficiency cited on today's visit.
A notice of site visit was given and must remain posted for 30 days.
Exit interview was conducted and report was reviewed with the Teacher, Iliana Carrasco.

Report Ends - Page 1 of 1
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023
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 1