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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414037
Report Date: 09/20/2019
Date Signed: 10/01/2019 02:25:15 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:CCRC HEAD START-RESEDAFACILITY NUMBER:
197414037
ADMINISTRATOR:ARACELI GROSSMANFACILITY TYPE:
850
ADDRESS:18120 SATICOY STREETTELEPHONE:
(818) 256-1066
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY:80CENSUS: 54DATE:
09/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Araceli GrossmanTIME COMPLETED:
01:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Silva Garibyan arrived at the above facility to conduct a Case Management Incident inspection. The self - reported incident occurred at CCRC Head Start - Reseda on 08/22/19. The El Segundo Regional Office received the incident report on 08/23/19. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

" On 08/22 around 10:46 am while headed to the playground, Staff#1 and Staff #2 were leading 14 children into room 2. While entering the classroom, Staff #2 moved from the end of the line to hold the door as children entered. Staff #2 closed the door not realizing Child #1 was there. Around 10;47 Staff #3 entered room 2 and hands child to Staff #4 ."

The incident involves a possible lack of supervision issues.

Based on the information obtained from the interviews conducted: during transition from the bathroom to Room 2 ( to go out to the play yard) Staff #1 and Staff #2 walked with 14 children. Staff #1 was in front of the line with the children and Staff #2 was at the end of the line. As the children entered into Room 2 they were asked by a teacher to walk through the tables and block area. Staff #2 was directing the children as to which way to go and redirecting children from room #2 as they were walking into their class line. Staff #2 redirected a child from Room 2 who was also walking towards the door. At this time is when Staff #2 closed the door behind her thinking all of the children from Room 3 entered the room. They continued to walk outside onto the play yard. Approximately 10-15 seconds on the yard, Staff #4 from another room saw Child #1 on the courtyard and brought Child #1 to them. California Code of Regulations, Title 22, Division 12, Chapter 1, Article 06, Section 101229 (a)(1) is being cited on the attached LIC 809D page. Appeal rights were discussed and printed. Copy of this report was provided, Notice of Site visit issued.
Exit interview was conducted.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2019
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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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: CCRC HEAD START-RESEDA
FACILITY NUMBER: 197414037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/20/2019
Section Cited

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No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement is not met as evidenced by: Child #1 was left outside the classroom ( on the court yard) while other children
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were on the play yard. Staff #3 saw Child #1 on the court yard.
This is a type B dificiency as poses a potential risk to the health and safety of children in care
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attended the staff meeting.
Center Director agrees to provide a written statement on how the facility will comply with this requirement by 09/27/19
LIC624 was faxed to El Segundo office on 08/27/2019

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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: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2019
LIC809 (FAS) - (06/04)
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