192006561-1-28-2020-33-CC-JMOA-BL9TKB-20200128134741

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192006561
Report Date: 01/28/2020
Date Signed: 01/28/2020 01:47:45 PM

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:	ALISO PICO PRESCHOOL		FACILITY NUMBER:	192006561
ADMINISTRATOR:	ADRIANA HERMOSILLO		FACILITY TYPE:	850
ADDRESS:	1505 E. 1ST STREET		TELEPHONE:	(323) 269-6921
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY:	60	CENSUS: 46	DATE:	01/28/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Adriana Hermosillo		TIME COMPLETED:	02:05 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 Analyst (LPA) Judy Mora conducted a case management inspection due to an Unusual Incident Report that occurred on 01/14/2020. Director, Adriana Hermosillo was not present at the time of arrival but arrived during this inspection. LPA conducted interviews and obtained documentation during this visit. The incident that occurred on Tuesday, January 14, 2020 was reported to the Department on the same day via telephone. The facility reported the unusual incident within the required 24 hours. On 01/14/2020, child #1 was playing with a toy wheel chair in the house area located in Class B. The child was pushing the wheelchair on her knees, the foot rest of the wheel chair flipped back hitting the child in the middle of her eyes causing a facial laceration. Staff #1 observed the incident and immediately administered first aid. The child did require medical attention, glue was placed on the wound. The facility has removed this toy wheel chair from the classroom. Based on all information obtained on this date, and interview conducted with teachers, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit. *REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALISO PICO PRESCHOOL	FACILITY NUMBER: 192006561
	VISIT DATE: 01/28/2020

NARRATIVE

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LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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. Failure to maintain posting as required will result in a civil penalty of $100.00.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Licensee. Appeal rights explained & provided.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 981-3371
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020

LIC809 (FAS) - (06/04)

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