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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890419
Report Date: 03/13/2024
Date Signed: 03/13/2024 04:14:28 PM


Document Has Been Signed on 03/13/2024 04:14 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:LEMAY STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191890419
ADMINISTRATOR:CURD, JOHANNAFACILITY TYPE:
850
ADDRESS:17553 LEMAY ST.TELEPHONE:
(818) 345-0731
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY:113CENSUS: 56DATE:
03/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH: Edita Kupelian, PrincipalTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incident that occurred on 12/15/2023. LPA arrived at the facility at 12:48PM and met with Edita Kupelian, Principal, who guided LPA on a tour of the facility. There were 56 children and 10 staff present upon arrival.

The incident that occurred on 03/01/2024, was reported to the Department on 03/04/2024, 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 staff did not provide adequate supervision resulting in Child#1 being left in the bathroom.

While interviewing staff, Staff #1, Staff #2, Staff #3 and Staff#4 disclosed Child #1 was observed walking into the classroom from the outdoors alone. The other children in care were in the classroom in their cots. All staff responsible for the care and supervision of Child#1 were in the classroom with the other children.
Staff #3 stated that child spontaneously disclosed that Staff #2 left them in the bathroom.

Based on interviews, and statements of admission provided by Staff #2, it was determined that indeed Child #1 was left in the bathroom when Staff #2 walked back to the classroom with the other children. This was an immediate risk to the health and safety of children in care.

California Code of Regulations, Title 22, Division 12 Chapter 1, 101229(a)(1) Responsibility for Providing Care and Supervision is being cited on the attached LIC9099D.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
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


Document Has Been Signed on 03/13/2024 04:14 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: LEMAY STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191890419

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/15/2024
Section Cited
CCR
101229(a)(1)

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to meet the children's needs... Supervision shall include visual observation.

This requirement was not met as evidenced by
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Per Principal, a meeting is scheduled for staff to discuss care and supervison. Principal will submit an agenda,attendance sheet and staff signatures by email to LPA by POC due date.
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Based on interviews, and statements of admission provided by Staff #2, it was determined that indeed Child #1 was left in the bathroom when Staff #2 walked back to the classroom with the other children which 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: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: LEMAY STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191890419
VISIT DATE: 03/13/2024
NARRATIVE
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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. A copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports was provided during this visit.

The Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted and report was reviewed with Edita Kupelian, Principal
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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3