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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416531
Report Date: 07/05/2022
Date Signed: 07/05/2022 12:12:30 PM


Document Has Been Signed on 07/05/2022 12:12 PM - It Cannot Be Edited

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. IIIFACILITY NUMBER:
197416531
ADMINISTRATOR:THERESA HOLMESFACILITY TYPE:
850
ADDRESS:4724 S. WILTON PLACETELEPHONE:
(323) 299-7243
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:46CENSUS: 11DATE:
07/05/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sheriee James, DirectorTIME COMPLETED:
12:30 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alicia Mooberry conducted an unannounced case management inspection. LPA met with Sheriee James, Director, who provided on a tour of the facility. There were 11 and 4 staff upon arrival.

LPA Mooberry conducted children's record reviews during a prior visit and found that the facility failed to report Incidents which occurred around 4/7/22 involving child #1 and on 4/12/22 involving child #2. This poses a potential risk to the health and safety of children in care.

In addition, the facility roster was found to be missing vital information which if not completed poses a risk to the health and safety of children in care.
Deficiencies are cited today in accordance with Title 22 Regulation.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit made 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 Licensee, including Appeal Rights and agency's consultative role.
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
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


Document Has Been Signed on 07/05/2022 12:12 PM - It Cannot Be Edited

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: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited

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(d) Upon the occurrence, during the operation of the child care center...a report shall be made to the Department..next working day... Events reported shall include the following: Any suspected physical or psychological abuse of any child.
The requirement was not met as evidenced by:
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Based on record reviews and interviews, the facility failed to report Incidents which occurred around 4/7/22 involving child #1 and on 4/12/22 involving child #2. This poses a potential risk to the health and safety of children in care.
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Type B
07/08/2022
Section Cited

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Each child day care facility shall maintain a current roster of children who are provided care in the facility...shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician.
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: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia MooberryTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2