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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409567
Report Date: 07/03/2019
Date Signed: 07/03/2019 12:52:03 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:CHILDREN OF OUR SAVIOR PRE-SCHOOLFACILITY NUMBER:
197409567
ADMINISTRATOR:CHARSHA, BEVERLYFACILITY TYPE:
850
ADDRESS:6705 W. 77TH STREETTELEPHONE:
(310) 215-3166
CITY:WESTCHESTERSTATE: CAZIP CODE:
90045
CAPACITY:144CENSUS: 91DATE:
07/03/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Katia Pacheco, Assistant DirectorTIME COMPLETED:
12:50 PM
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On 07/3/2019 at 11:10 am, Licensing Program Analyst (LPA) Denise Miranda, conducted an unannounced inspection at Children of our Savior Preschool for the purpose of following up on the self reported incidents that occurred at the facility on 5/28 and 5/30. The reports were received by the El Segundo Regional Child Care Office on 05/30/2019. LPA met Katia Pacheco, Assistant Director.
At 11:25am, LPA observed 91 preschool children present being supervised by 7 teachers and 6 teachers assistant at the time of this visit.

On 5/28/19 according to the report, child#1 was observed while child’s#2 had the pants down. On 5/30/19 according to the report, child #1 was observed while child#3 had the pants down.

LPA obtained copy of the sign in sign out, child#1,child#2 and child#3 information emergency card, sign in/sign out staff. Assistant Director will send by email no later than today copy of written plan of action.

LPA provided a copy of title 22: 101210 reporting requirements: Division 12, Chapter 1, Article 6 continuing Reporting. LPA advised Assistant Director to review and provide training to all staff.

Based on the information that were gathered through interview, it revealed that on the day of the incident date 5/28/19, there were 4 children with 3 teachers present and 5/30/19 , there were 3 children with 1 teacher. To prevent similar incident from reoccurring, director will continue to provide training to teachers regarding lack of supervision, personal rights and report requirements.
At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

The content of this report was read and discussed in detail at the time of with the noted contact person.
An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Katia Pacheco, Assistant Director.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
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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