191870697-7-25-2019-54-CC-JCHZ-BEEQ6C-20190725115318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870697
Report Date: 07/25/2019
Date Signed: 07/25/2019 11:53:29 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:	EASTMAN AVENUE EARLY EDUCATION CENTER		FACILITY NUMBER:	191870697
ADMINISTRATOR:	ELIZABETH MARES		FACILITY TYPE:	850
ADDRESS:	1266 S. GAGE		TELEPHONE:	(323) 268-7408
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90023
CAPACITY:	114	CENSUS: 69	DATE:	07/25/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Nicole Diaz		TIME COMPLETED:	12:15 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	Licensing Program Analysts (LPAs) Janeth Chavez and Denise Gibbs conducted an unannounced case management inspection due to two incidents reported to the department. LPAs met with Nicole Diaz who guided analysts on a tour of the facility to obtain a census of the staff and children present. There are 69 children with 16 staff present. All staff present have obtained a criminal record clearance or exemption as a condition of employment throug LAUSD. LPA conducted interviews and obtained documentation during this case management inspection. The Department received two Unusual Incidents that occurred on 06/10/2019 & 06/28/2019 alleging that the personal rights of Child#1 and Child#2 may have been violated by Staff#2. The incident that occurred on 06/10/2019 was reported to the Department on 06/11/2019 via fax. The facility reported the incident within the required 24 hours of occurrence via fax. The incident indicated that a child’s personal rights may have been violated. Allegedly Staff #1 witnessed Staff#2 slam Child#1 onto the cot because Child#1 would not stop crying during nap time. Staff#1 witnessed this incident and a written declaration was obtained. LPAs attempted to interview Child #1 and there were no disclosures made by the child. As per Adult#2 the child is non-verbal. Staff#2 is no longer employed at the facility as of 06/28/2019 and thus could not be interviewed. The incident that occurred on 06/28/2019 was reported to the Department on 07/01/2019 via phone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. The written report was received on 07/01/2019. The incident indicated that a child’s personal rights may have been violated. Allegedly, Staff#2 hurt Child#2 by pulling child’s arm. LPAs interviewed Child#2 and stated that Staff#2 hurt child's hand. Child#2 demonstrated to LPAs how Staff#2 hurt child's hand. Report Continues on next page 1 of 2

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: EASTMAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870697
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/25/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/27/2019 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toiletting.	1 2 3 4 5 6 7	Director Mares stated that Staff#2 is no longer employed at the center as of 06/30/2019. Mrs. Mares stated she will provide training to staff in regards to Abolition of Corporal Punishment, Child Abuse Reporting Requirements, Respecting Chidren's Personal Rights, & Identification of appropriate nap time strategies when a
	8 9 10 11 12 13 14	This requirement is not met as evidenced by Staff #1 witnessing Staff#2 slamming Child#1 onto the cot during nap time. Child#2 disclosed that Staff#2 hurt child's arm to Adult #1. This is an immediate health and safety risk to children in care.	8 9 10 11 12 13 14	child does not want to sleep. Director will provide an updated sign in sheet with signatures of employees and the date the training is provided.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

LIC809 (FAS) - (06/04)

Page: 3 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: EASTMAN AVENUE EARLY EDUCATION CENTER	FACILITY NUMBER: 191870697
	VISIT DATE: 07/25/2019

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
26
27
28
29
30
31
32

For the incident that occurred on 06/10/2019, based on facility’s own submission of the Unusual Incident Report that indicates that Staff#1 witnessed Staff#2 slam a child onto Child#1’s cot during nap time, and interviews conducted it is determined that Child#1’s personal rights were violated. For the incident that occurred on 06/28/2019, based on the facility’s own submission of the Unusual Incident Report that indicates that Staff#2 hurt Child#2 by pulling child’s arm, and Child#2 disclosures that Staff#2 hurt child's arm, it is determined that Child#2’s personal rights were violated. Therefore, based on the incidents, the following deficiencies listed on the attached deficiencies page are being cited in accordance with California Code of Regulations Title 22.

Whenever a type A is cited: “Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months.”

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 Elizabeth Mares, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

End of Report page 2 of 2

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Janeth Chavez	TELEPHONE: (323) 981-3376
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2019

LIC809 (FAS) - (06/04)

Page: 2 of 3