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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416559
Report Date: 06/21/2019
Date Signed: 06/21/2019 12:37:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHASE EARLY EDUCATION CENTERFACILITY NUMBER:
197416559
ADMINISTRATOR:WINBUSH, TERRIFACILITY TYPE:
850
ADDRESS:8635 NORTH COLBATH AVENUETELEPHONE:
(818) 830-4455
CITY:PANORAMA CITYSTATE: CAZIP CODE:
91402
CAPACITY:168CENSUS: DATE:
06/21/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Edita Kupelian - Head Teacher TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Peter Flores, conducted a Case Management Incident inspection to follow up on the self reported incident that occurred at Chase Early Education Center on March 15, 2019. The El Segundo Child Care Office received the incident report via fax on March 15, 2019.

LPA met with Head Teacher's Edita Kupelian and Meliza Rodriguez, who guided analyst on a tour of the facility. LPA observed 121 children present and 21 staff members.

On the unusual incident, reporter stated that a staff member violated a child's Personal Rights.

LPA interviewed staff.

Director took proper Administrative Action for the incident. Facility will be cited for 101223 (A)(2)Personal Rights Type A under Title 22.

The notice of site visit must be posted for 30 days upon receipt.

An exit interview was conducted and a copy of this report was given to Edita Kupelian, Head Teacher.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
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: CHASE EARLY EDUCATION CENTER
FACILITY NUMBER: 197416559
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/21/2019
Section Cited
CCR
101223(A)(2)
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Staff violated child's Personal Rights
The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and
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Incident happened on 03/15/2019, Director conducted a meeting with staff on 03/18/2019. The incident was addressed immediately. Documentation was submitted to the Department during visit.
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comfortable accommodations, furnishings and equipment to meet his/her needs.
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Plan of Correction has been met.
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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: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2019
LIC809 (FAS) - (06/04)
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