191890476-1-3-2020-30-CC-DADS-BKGRHL-20200103120232

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191890476
Report Date: 01/03/2020
Date Signed: 01/03/2020 12:02:47 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:	SYLVAN PARK EARLY EDUCATION CENTER		FACILITY NUMBER:	191890476
ADMINISTRATOR:	SAINZ-ANDERSON, CARMELA		FACILITY TYPE:	850
ADDRESS:	15011 DELANO ST.		TELEPHONE:	(818) 997-8972
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91411
CAPACITY:	166	CENSUS: 59	DATE:	01/03/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Wendy Workman		TIME COMPLETED:	12:30 PM

NARRATIVE

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On 1/3/2019 at 10:15 a.m., Licensing Program Analysts Dalicia Adkins arrived at SLYVAN PARK EARLY EDUCATION CENTER – to conclude investigation of a self reporting incident that occurred on 11/21/19 involving child #1 being left alone without supervision.

Upon arrival LPA meet with Wendy Workman who guided LPA on a tour throughout the facility. LPA observed six operating classrooms. Room #1A: 11 children , 1 teacher and 2 assistants. Room #1B: 11 children , 1 teacher, 2 assistants and 1 floater. Room #2: 11 children 1 teacher , 2 assistants. Room# 3; 5 children 1 teacher (sub) , 1 floater. Room #4 : 9 children, 3 assistants 1 teacher ( on break). Room #5: 12 children 3 assistants, 1 teacher (on break).

Prior to today's visit an an un- announced was conducted on 12/06/19 to investigate incident reported on 11/21/19. LPA's reviewed staff files and evaluated staff qualifications. LPA's reviewed and discussed supportive documents: staff qualifications, emergency plan handbook polices and procedures, sign in and out sheets, health check roster, emergency drills schedules, policy and procedures training. LPA's collected copies of Policy and Procedures Training, EEC Emergency Drill Schedule 2019-2020, Drill Schedule 10/17/19-6/23/20 (Fire Drill, Earthquake Drill, Shelter in Place, Lock Down), Policy and Procedure Training 1/29/2018, and Los Angeles Unified School District Early Childhood Education Division -Sylvan Park Early Education Center 2019-2020 Staff Handbook. LPA's interviewed Director, teachers , teacher aids, floater and Child #1.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SYLVAN PARK EARLY EDUCATION CENTER	FACILITY NUMBER: 191890476
	VISIT DATE: 01/03/2020

NARRATIVE

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Based on observation and interviews on 12/06/2019 it has been determined that above facility failed to meet title 22 regulation, 101229 Responsibility for Providing Care and Supervision. On 11/21/2019 Child #1 was left alone in Classroom (1A) for approximately 7 minuets. Staff #1 stated that Child #1 was left alone in the classroom (room 1A) for about 7 minuets while conducting a fire drill. Staff#1 states that child #1 got in the line but did not recall seeing the child exit the classroom. Staff #1 states that Child #1 was noticed missing after reaching designated site on playground and conducting roll call. Staff #1` witnessed staff return child #1 to class on the playground. Staff #2 witnessed child #1 exit classroom alone and returned Child #1 to teacher on playground. Staff #3 states that Child #1 was not present when Staff #1 was conducting roll call.

(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1)No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall

In accordance with California Code of Regulations, Title 22 Child Care Regulation above facility was sited (1) deficiency during today's visit 1/3/2020: Title 22, 101229 Responsibility for Providing Care and Supervision, Type B violation pose potential risk to the health, safety of children.

An exit interview was conducted, and a copy of this report was furnished to Teacher Wendy Workman for review. Notice of site visit and appeal rights furnished for review and posting.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: SYLVAN PARK EARLY EDUCATION CENTER	FACILITY NUMBER: 191890476
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/03/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/03/2020 Section Cited	1 2 3 4 5 6 7	(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
	8 9 10 11 12 13 14	Teacher #1 states that child #1 was left behind in classroom during a fire drill. Child#1 was left behind for approximatley 7 minuets. This violation pose potential risk to the health of children in care..	8 9 10 11 12 13 14
	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: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Dalicia Adkins	TELEPHONE: (424) 301-3064
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020

LIC809 (FAS) - (06/04)

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