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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870699
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:24:01 PM


Document Has Been Signed on 06/11/2024 03:24 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:EL SERENO EARLY EDUCATION CENTERFACILITY NUMBER:
191870699
ADMINISTRATOR:RAFAELA CAMPOSFACILITY TYPE:
850
ADDRESS:3802 PUEBLO AVE.TELEPHONE:
(323) 221-2121
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:114CENSUS: 76DATE:
06/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Rafela Campos, Principal TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPAs) Roxana Lopez and Saul Valenzuela conducted an unannounced Case Management Incident inspection to follow up on 1 incident that was reported to the Department on 05/02/2024. LPA met with Principal Rafaela Campos who guided LPAs on a tour of the facility. Census was taken.

On May 2nd 2024, an incident was self reported to the Department via Email by the facility who reported that child # 1 tripped in the classroom hitting their chin on a table. Child had a cut that required 4 stiches.



All reports were reported within the required 24 hours. The purpose of the inspection was to obtain additional information regarding the incident reported to the Department.

During the inspection, LPA Lopez conducted interviews with staff. Interviews disclosed that child # 1 ran to greet a teacher and tripped hitting their chin on a table. First aid was provided- child was taken to the doctor and received 4 stiches. Doctor's note is on file- child returned with no restrictions.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

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

Exit interview conducted and report was reviewed with facility representative, Rafela Campos

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
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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