197416531-5-11-2021-54-CC-AMOY-C2X69T-20210511203717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416531
Report Date: 05/11/2021
Date Signed: 05/11/2021 08:38:56 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:	PAGE LEARNING ACADEMY, INC. III		FACILITY NUMBER:	197416531
ADMINISTRATOR:	THERESA HOLMES		FACILITY TYPE:	850
ADDRESS:	4724 S. WILTON PLACE		TELEPHONE:	(323) 299-7243
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90062
CAPACITY:	46	CENSUS: 10	DATE:	05/11/2021
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Sheriee James, Director		TIME COMPLETED:	05:00 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

Licensing Program Analyst (LPA) Alicia Mooberry conducted a case management deficiencies inspection. Due to COVID-19 and precautionary measures, this inspection was conducted via teleconference. LPA met with Director Sheriee James who provided tour of the facility.

While touring the facility. LPA observed staff, Lissette Gutierrez, Aide, in the toddler room with children. Per director, said staff is an Aide and is cleared and associated to the facility. LPA reviewed the Licensing Information System (LIS) personnel roster for this facility and found that Aide is not on the list. Therefore, it was determined the Aide was not cleared to work in the facility. Record reviews indicated that Aide has been in the facility more than 5 days. This is an immediate risk to the safety of children in care.

A civil penalty of $500 is being issued in accordance with California Code of Regulations Title 22 and Health & Safety codes. Please refer to 809D pages for documentation of citation.

A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Sheriee James, Director. Appeal Rights were discussed and provided.

*A copy of this report, Appeal Rights, Notice of Site Visit and the Acknowledgement of Receipt of Licensing Reports Form was sent to director via email with a return receipt request in lieu of signature.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: PAGE LEARNING ACADEMY, INC. III	FACILITY NUMBER: 197416531
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/11/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/11/2021 Section Cited	1 2 3 4 5 6 7	Personnel Requirements - Prior to employment or initial presence in the child care center, all employees and volunteers subject to a criminal record review shall obtain a California clearance or...exemption... This requirement is not met as evidenced by:
	8 9 10 11 12 13 14	LPA obeserved Lissette Guiterrez in the Toddler room providing supervision. Per Director, Ms. Gutierrez is cleared and associated to the facility. However, Individual was not found on association list.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/11/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2