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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870893
Report Date: 03/09/2020
Date Signed: 03/09/2020 04:59:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:NINETY FIFTH STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191870893
ADMINISTRATOR:CHILDRESS, CANDIEFACILITY TYPE:
850
ADDRESS:1027 W 96TH STREETTELEPHONE:
(323) 777-0920
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:116CENSUS: 10DATE:
03/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Principal Hilarie Dyson TIME COMPLETED:
05:10 PM
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On 3/9/20., Licensing Program Analyst (LPA) Dalicia Adkins Ninety Fifth Street Early Education Center -191870893 to conduct an unannounced case-management incident visit to follow up on an unusual Incident that occurred at the facility on 1/14/20. LPA met with Principal Hilarie Dyson. LPA who was informed for the reason for the visit. Director guided LPA on a tour of the facility.

LPA observed at 4:40pm LPA observed 10 children and 3 teachers. LPA reviewed ,children’s sign in/out sheets, activity schedule posted in classroom. LPA: collected Child/Teacher Roster.

The department received a self reported unusual incident report on 1/15/20 at 4:30pm regarding abuse. It was self reported by Principal Hilarie Dyson.


Principal was given Copy of Notice of Site Visit was furnished.

During the inspection, LPA interviewed Principal Hilarie Dyson. Based Today’s 3/9/20 observations, record review and interview it was determined that the unusual incident report requires further investigation.

An exit interview was conducted, and a copy of this report was furnished to Principal Hilarie Dyson for review. Notice of site visit was furnished for review and posting.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia AdkinsTELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
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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