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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408763
Report Date: 02/01/2021
Date Signed: 02/01/2021 02:28:29 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:WEST HOLLYWOOD CHILDREN'S ACADEMYFACILITY NUMBER:
197408763
ADMINISTRATOR:JOULIANA BARANOVAFACILITY TYPE:
850
ADDRESS:1030 N. VISTA STREETTELEPHONE:
(310) 748-1656
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:35CENSUS: 18DATE:
02/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Julia Baron, Director TIME COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPAs), Denise Miranda conducted a Case management deficiency visit during an initial 10-day Complaint investigation. Upon arrival LPA was greeted by Jennifer Jeronimo, Teacher, Director was not present. At 9:37am LPA observed Director arrived at the facility and LPA disclosed the reason of the visit.

During the investigation LPA observed the following deficiency:

Licensee was unable to produce the file of staff # 5.

Please see LIC809D.



Deficiency is cited during today’s visit. An exit interview conducted. Licensee had a copy of this report.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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 2
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: WEST HOLLYWOOD CHILDREN'S ACADEMY
FACILITY NUMBER: 197408763
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2021
Section Cited

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A teacher shall meet the requirements of Health and Safety Code Section 1597.055.
This requirement is not met as evidenced by: On 02/01/2021, a review of records was conducted and LPA observed
that Director was unable to provide file of Staff#5 to review.
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This is a Type B citation and poses a potential health and safety 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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2