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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411833
Report Date: 12/17/2019
Date Signed: 12/17/2019 02:29:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LITTLE STARS LEARNING CENTERFACILITY NUMBER:
197411833
ADMINISTRATOR:MORALES, LUISFACILITY TYPE:
850
ADDRESS:4103 W. ADAMS BLVD.TELEPHONE:
(323) 732-2224
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:64CENSUS: 48DATE:
12/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Luis Morales, DirectorTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Denise Gibbs conducted an unannounced case management inspection on 12/17/19 at 1:00 PM. Upon arrival, LPA met with Director Luis Morales. There were 48 children present during inspection.

On 10/14/19, Licensee submitted an unusual incident/injury report to the Department. LPA interviewed Director and teacher who witnessed the incident. LPA reviewed child's record and reviewed pertinent documentation. Per report Child #1 climbed on a picnic table, jumped off landing on her bottom in the grassy area. Pictures of table and grass area were obtained. Parents took child to the doctor the next day and discovered C1 had a broken elbow. Per Director, parents did not submit medical documentation.

Per S1, child continued playing and resumed her regular schedule of eating and sleeping without any concern after incident. Parent inquired about child's injury at pick up and was notified about the incident. LPA observed the outdoor area where the incident occurred and determined that there was visual supervision of all children.

After the incident on 10/14/19, Director conducted a training with staff regarding outdoor supervision and injury reporting.

At this time based on the available information it does not appear this incident was the result of a Title 22 violation and the facility followed the appropriate regulations to care for the children in care.

Upon receipt, Notice of Site Visit shall be posted. Notice of Site Visit shall be posted for thirty (30) days. Failure to maintain posting as required will result in a $100 civil penalty.

Exit interview was conducted with Director Luis Morales. Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise GibbsTELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2019
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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