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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890457
Report Date: 01/30/2020
Date Signed: 01/30/2020 02:02:16 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:TOLUCA LAKE EARLY EDUCATION CENTERFACILITY NUMBER:
191890457
ADMINISTRATOR:KAZARIAN, VIKENFACILITY TYPE:
850
ADDRESS:4915 STROHM AVETELEPHONE:
(818) 980-0925
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:119CENSUS: 89DATE:
01/30/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Ade Hernandez TIME COMPLETED:
02:00 PM
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On 1/30/20 at 10:50 a.m., Licensing Program Analyst (LPA) Dalicia Adkins arrived at Toluca CA Lake Early Education Center- 191890457 to conduct an un announced case management visit to follow up on an Unusual Incident that was reported on the department on 1/13/2020. LPAs met with Principal Ade Hernandez who was informed for the reason for the visit. Principal guided LPA on a tour of the facility.

LPA observed classrooms while children were napping: Room 1B (preschool) 11 children, Room 1A (preschool) 22 children, Room #2 (2 years old ) 19 Children , Room 3A (preschool) 19 Children, Room 3B (4-5yrs ) 18 children. Today's 1/30/20 Children Census: 89( two children left)

LPA interviewed Staff #1, Teacher #2 (Teacher Room 1B) and Teacher #3 (Teacher 1B). LPA collected and reviewed supportive documents: Los Angeles Unified School District Toluca Lake Early Education Center Schedule, Classroom Roster (teachers) and Child #1 Record.

The department received a self reported unusual incident reported on 1/13/20: Child#1 was hit on the head.

During investigation LPA discussed reporting requirements, staff development training, interviews/investigation procedures. Based on today’s investigation/ interviews/ supportive documents/ classroom observation, it was determined that incident requires further investigation. During today visit 1/30/2020 facility did not receive any deficiencies or penalties.

LPA collected the following documents: Teacher Classroom Roster, Activity Schedule, Child #1 Record. An exit interview was conducted, and a copy of this report was furnished to Principal Ade Hernandez 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: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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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