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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870707
Report Date: 04/09/2024
Date Signed: 04/09/2024 03:03:27 PM


Document Has Been Signed on 04/09/2024 03:03 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:COLLINS EARLY EDUCATION CENTERFACILITY NUMBER:
191870707
ADMINISTRATOR:ELIZABETH BLACKWELLFACILITY TYPE:
850
ADDRESS:901 WEST 52ND STREETTELEPHONE:
(323) 752-2119
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:114CENSUS: 57DATE:
04/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elizabeth Blackwell, PrincipalTIME COMPLETED:
03:30 PM
NARRATIVE
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On 04/09/2024 at 1:30 PM, Licensing Program Analysts (LPAs) Katrina Chicote and Claudia Kam conducted an Unannounced Case Management Inspection to follow up on several incidents reported to The Department. All incidents were reported within 24 hours of when incident occurred and written report submitted within seven days. LPAs announced purpose of visit and met with Facility Representative (FR) Dr. Elizabeth Blackwell, Principal. Census was taken.

On 12/13/2023, there was an incident reported in regards to C4 being left unsupervised in the hallway. Per Principal, she observed C4 in hallway and talked to him about why he was outside and C4 stated he was waiting to go into the classroom. Principal states that she brought C4 into the classroom and interviewed Staff, obtaining written statements from staff to confirm observation made by Principal. Principal states that there was a miscommunication with the staff which resulted in C4 being left unsupervised. Principal states S3 has had a conference memo pending disciplinary action. Principal states as a result of this incident a "The Art of Active Supervision" training was provided on 01/05/2024 and LPAs reviewed sign in sheet for training, confirming all staff were present during training. Based on information provided, a Type A deficiency is going to be cited as this is an immediate health, safety, and personal rights risk to children in care.

On 12/14/2023, 02/13/2024, 03/15/2024, and 03/21/2024 several incidents were reported to Department in regards to a parents making allegations towards child's personal rights being violated. Principal states that they followed LAUSD protocol in regards to these types of incidents which includes reporting to multiple Agencies, including the Police Department. Police Department provided directive that incidents must be handled internally. Principal stated she did thorough investigation which includes written statements and interviews, LPAs reviewed these documents at time of inspection.


Per Principal, C1’s Authorized Representative had a history of making allegations and threats against staff. Per last Case Management visit on 12/07/2023, this was involving the same child and Authorized
Report Continues - Page 1 of 2
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: COLLINS EARLY EDUCATION CENTER
FACILITY NUMBER: 191870707
VISIT DATE: 04/09/2024
NARRATIVE
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Representative. At this time, child no longer attends facility as Authorized Representative removed child. Principal conducted internal investigation in regards to allegations made by C1’s Authorized Representative and findings were always unfounded.

Per Principal, there were four witness statements taken in regards to allegation involving C2. LPA reviewed witness statements to corroborate information provided by Principal that children did not even go outside that day due to the weather, which is conflicting information provided in unusual incident report. Per Principal, C2 currently still attends facility and are now working in partnership with C2’s Authorized Representative and no other issues has occurred.

Per Principal, during her internal investigation, which includes interviews of C3, C3’s Authorized Representative, and Staff written statements, C3 was able to provide consistent statements in regards to allegations made in unusual incident reports. Staff statements also provide corroborating information in regards to incidents reported. Per Principal, C3 is still currently attending but has been transferred to another room with different staff. Per Principal, she is about to conclude internal investigation and pending disciplinary actions towards S1 and S2. Principal states they will submit update to LPA once investigation is concluded. Based on information provided, the allegations seem to be substantiated though a swift response and follow up in regards to incidents were conducted by Agency, no deficiency will be cited at this time for these incidents.

Based on this information, the following deficiency on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business 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 of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Facility Representative, Elizabeth Blackwell.
Report Ends - Page 2 of 2

SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/09/2024 03:03 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: COLLINS EARLY EDUCATION CENTER
FACILITY NUMBER: 191870707

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide.. supervision... (1) No child(ren) shall be left without the supervision of a teacher at any time,.. shall include visual observation.
This regulation was not met as evidenced by:
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FR states as a result of incident, she has conducted a training on active supervision with staff on 01/05/2024. LPA conducted record review of training sign in sheets. Clearing deficiency on this date.
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Based on LPAs interview, FR states that she observed C4 left unattended in hallway and discussed observation with teachers at time of incident. This poses an immediate health, safety, and 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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 04/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/09/2024
LIC809 (FAS) - (06/04)
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