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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870909
Report Date: 07/12/2023
Date Signed: 07/12/2023 12:55:16 PM


Document Has Been Signed on 07/12/2023 12:55 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WESTMINSTER AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191870909
ADMINISTRATOR:SCRUGGS, LIZAFACILITY TYPE:
850
ADDRESS:1010 MAIN ST.TELEPHONE:
(310) 392-4581
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY:117CENSUS: 55DATE:
07/12/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Felicia Torrence- PrincipalTIME COMPLETED:
12:54 PM
NARRATIVE
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On 7/12/2023, Licensing Program Analyst's (LPA) Suzette Ornelas conducted an unannounced case management inspection for the purpose of deficiencies observed during a complaint investigation on 4/24/2023 for complaint control # 58-CC-20230417145953. Upon arrival LPA was greeted by Felicia Torrence- Principal and observed 55 children and 12 adults.

LPA Ornelas investigated complaint control # 58-CC-20230417145953. According to the complaint investigation report received on 4/17/2023, day care child put a foreign object in their mouth.

Based on an interview conducted with the Interim Principal, it was confirmed that the incident was not reported to the Department within 24 hours. No direct contact with the on duty worker or the analyst was made within 24 hours.

During todays visit, LPA explained to the Principal that when an incident occurs, according to Title 22 Regulations, the incident must be reported to the department within 24 hrs., and a written report using the unusual incident /injury report LIC624 form must be filled out and mailed or emailed to the department within 7 days. Principal understands and will comply.

The following Type B deficiency is being cited on 7/12/2023 in accordance to Title 22 of the California Code of Regulations: 101212(d) Reporting Requirements. A report shall be made to the Department within 24 hours of the occurrence of any unusual incident as specified. Please refer to 809D for cited deficiencies.

A copy of this report, notice of site visit, and appeal rights were provided. 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.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
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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Document Has Been Signed on 07/12/2023 12:55 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: WESTMINSTER AVENUE EARLY EDUCATION CENTER
FACILITY NUMBER: 191870909

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2023
Section Cited
CCR
101212(d)

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 Reporting Requirements: (d)Upon the occurrence, during the operation of.. child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone..within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
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LPA informed Principal of reporting requirements. The importance of telephoning the incident and following up with the required written report. LPA will obtain a written UIR LIC624 from Principal today.
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This requirement is not met as evidence by: On 4/14/2023, a child put a small toy ball in their mout and the staff member had to physically remove the toy from the childs mouth. Incident was not reported to the licensing department as unusual incident.
This is a type B dificiency as poses a potential risk to the health and safety of children in care.
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During todays visit, Principal completed the LIC624 and cleared the deficiency.

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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: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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