191890387-4-11-2023-58-CC-LHEZ-CQT2SF-20230411173904

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191890387
Report Date: 04/11/2023
Date Signed: 04/11/2023 05:39:13 PM

Document Has Been Signed on 04/11/2023 05:39 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:	LAUREL EARLY EDUCATION CENTER		FACILITY NUMBER:	191890387
ADMINISTRATOR:	GEORGE, BARBARA		FACILITY TYPE:	850
ADDRESS:	8023 WILLOUGHBY		TELEPHONE:	(323) 654-0812
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	117	CENSUS: 39	DATE:	04/11/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:59 PM
MET WITH:	Keran Paysinger, Principal		TIME COMPLETED:	05:45 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	Licensing Program Manager (LPM) Rita Ramos and Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incident that occurred on 04/03/2023. LPM and LPA arrived at the facility at 1:59PM and met with Karen Paysinger, Principal, who guided LPM and LPA on a tour of the facility. There were 39 children and 9 staff present upon arrival. The purpose of the visit was to follow-up on an incident that was reported to the department. LPA Hernandez conducted interviews, took pictures, obtained documentation, and took measurements during this visit. The incident that occurred on 04/03/2023, was reported to the Department on 04/04/2023, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. Information reported to the Department indicated that Child #1 singularly eloped and walked out the gated door and one of the staff went after the child. A passerby who was walking down the street pointed to where they had seen the child. Principal stated that child was unharmed and brought back to the school. Based upon information received from the interviews conducted it was determined that Child #1 singularly eloped from the facility and no one observed the child exit the yard. Per Principal Paysinger and staff interviewed, none of the staff observed when the child eloped from the facility. PAGE 1

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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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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: LAUREL EARLY EDUCATION CENTER	FACILITY NUMBER: 191890387
	VISIT DATE: 04/11/2023

NARRATIVE

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Staff #2 heard the gated door close shut and decided to look for Child #1. Per Principal, Staf #2 found Child #1 pass the corner of Willoughby Avenue and Edingburgh Avenue. Staff #2 asked a female passerby walking their dog if they had seen a child walk by and the female passerby confirmed and pointed to the direction that the child was seen walking on sidewalk on Willoughby Avenue. Staff #2 walked over to the child and brought child back to the facility.

LPA took measurements based on information provided by the Principal and it was determined that Child#1 was found approximately 280 feet away from the facility.

This is a repeat violation. On 10/17/2022, a similar incident occurred involving another child eloping from the facility.

The following deficiency listed on the attached deficiency page is being cited in accordance with California Code of Regulations Title 22.

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 form must be maintained in each child’s file immediately upon receipt from parent. Principal was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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. Exit interview was conducted with Karen Paysinger, Principal including, but not limited to Provider Rights, Appeal Procedures.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided during this visit. ---PAGE 2

SUPERVISOR'S NAME: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2023 05:39 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: LAUREL EARLY EDUCATION CENTER	FACILITY NUMBER: 191890387
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/11/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/12/2023 Section Cited	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision (a)(1)No child(ren) shall be left without the supervision of a teacher at any time... This requirement is not met as evidence by based on interviews	1 2 3 4 5 6 7	Per Principal, meeting with staff will take place on 4/12/2023 to review and update plans on care and supervison. A copy of the meeting agenda will be submitted by POC due date of 4/12/2023.
	8 9 10 11 12 13 14	conducted and statements made that Child #1 eloped and was not observed by staff which poses an immediate health, safety,or personal rights risk to persons in care.	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: Rita Ramos	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia Hernandez	TELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC809 (FAS) - (06/04)

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