<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890334
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:11:47 PM


Document Has Been Signed on 10/13/2023 02:11 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 HEAD STARTFACILITY NUMBER:
191890334
ADMINISTRATOR:MINA RODRIGUEZFACILITY TYPE:
850
ADDRESS:5036 HUNTINGTON DRIVETELEPHONE:
(323) 222-2786
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:40CENSUS: 15DATE:
10/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Mina Rodriguez, Lead TeacherTIME COMPLETED:
02:30 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
On October 13, 2023, Licensing Program Analysts (LPAs) Monique Ayala and Shushanik Safaryan conducted an unannounced case management inspection for an incident that occurred on 01/31/2023; the incident was reported timely to the department on 02/01/2023. A COVID-19 risk assessment was conducted prior to entering the facility. LPAs met with Mina Rodriguez who guided LPAs on a tour of the facility. LPAs observed 15 children in care.

Brief summary: On 01/31/2023, Child #1 (C1) was seen under one of the classrooms table in the dramatic play area with no staff supervision. C1 was found by Family Service Assistant. C1 was immediately reunited with the class and parent was notified; Agency will conduct an internal investigation.

During the inspection LPAs interviewed Family Service Assistant (Staff #1 (S1)), Staff #2 (S2), obtained a copy of internal incident report and a copy of the facility roster. Based on interviews conducted with S1 and S2, C1 was left unattended in the classroom. S1 stated that she was no aware C1 was in the classroom until she saw him under the table. C1 was left unattended for approximately 4 minutes.

The following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety. 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). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent.

An exit interview was conducted was conducted and copy of this report was provided to Lead Teacher Mina Rodriguez along with Notice of Site Visit and appeal rights. Notice of Site Visit must be posted for 30 days.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
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 2


Document Has Been Signed on 10/13/2023 02:11 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: EL SERENO HEAD START
FACILITY NUMBER: 191890334

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the children's needs. No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
1
2
3
4
5
6
7
Per lead teacher there was staff meeting on how to communicate head count of the children when transitioning.
8
9
10
11
12
13
14
This requirement was not met as evidence by: Based on interviews with S1 and S2, C1 was left unattended in the classroom for approximately 4 minutes before being found by S1 under the table.
8
9
10
11
12
13
14

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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2