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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413818
Report Date: 06/30/2023
Date Signed: 06/30/2023 09:41:17 AM


Document Has Been Signed on 06/30/2023 09:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:VOALA SANTA CRUZ HEAD STARTFACILITY NUMBER:
197413818
ADMINISTRATOR:CANDELARIA CABRERAFACILITY TYPE:
850
ADDRESS:201 NORTH BEACON STREETTELEPHONE:
(310) 831-3294
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY:46CENSUS: 0DATE:
06/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Maria Jimenez Lepe - Early Head Start Family AdvocaterTIME COMPLETED:
10:02 AM
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On 6/30/2023, Licensing Program Analyst (LPA) Suzette Ornelas conducted an unannounced case management visit for the purpose of following up on a self reported Unusual Incident. Report indicated that on 6/6/2023, child tripped in the restroom and obtained a cut on his lip which resulted in him getting 3 stitches.
LPA Ornelas met with Maria Jimenez Lepe - Early Head Start Family Advocate. LPA toured the facility and observed 0 children in care.

According to the report, on 6/6/2023 child was in the restroom washing his hands and went to grab a paper towel, when he tripped and bit his lip. First aid was applied and parents were called right away. Mother arrived to pick child up. Parent took child to urgent care. Mother reported on 6/7/2023 after business hours that child received 3 stiches to his lip area. Child will be out of school for 2 days.

During todays visit, LPA Ornelas observed the restroom where the incident occurred. LPA observed sinks, paper towel dispenser, toilets and trash cans to be low enough for children to easily reach. LPA obtained pictures, children's roster and 2 staff witnesses contact information.

Per Facility Representative, Incident occurred the week before the last week of school; therefore child did not return. On the last day of school mother arrived with child to pick up belongings and diploma and say good bye to his teachers. Child will not be returning to due to going to kindergarten in the fall.

Based on interviews, the facility was within ratio with two teachers supervising 13 children at the time of the incident. Center staff provided proper care and supervision during the time of the incident. At this time based on the information gathered, it does not appear this incident was the result of a Title 22 violation.

Exit Interview conducted and a copy of this report along with a Notice of Site Visit were provided to Maria Jimenez Lepe - Early Head Start Family Advocate.
SUPERVISOR'S NAME: Betty BellTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Suzette OrnelasTELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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