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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416573
Report Date: 01/18/2023
Date Signed: 01/18/2023 03:40:39 PM


Document Has Been Signed on 01/18/2023 03:40 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:WILLIAM R. ANTON EARLY EDUCATION CENTERFACILITY NUMBER:
197416573
ADMINISTRATOR:CYNTHIA CORCOLESFACILITY TYPE:
850
ADDRESS:831 NORTH BONNIE BEACH PLACETELEPHONE:
(323) 981-3670
CITY:LOS ANGELESSTATE: CAZIP CODE:
90063
CAPACITY:168CENSUS: 56DATE:
01/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Sandy Guillermo, Head Teacher &
Cynthia Corcoles, Principal		TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Case Management inspection due to an incident that was reported to the Department on January 17, 2023. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Sandy Guillermo, Head Teacher who guided LPA on a tour of the facility. Principal Cynthia Corcoles was present however, unavailable for the tour. Census was taken.

On January 17, 2023 an unusual incident report was made to the department regarding an incident that involved a child who had an allergic reaction that required medical attention. The facility reported this incident to the Department within the required 24 hours.



Based on information obtained during interviews conducted with staff, the parent of child in question, and records review, LPA Garcia determined that child had an allergic reaction that may have cause swelling of child’s left eye. Staff #1 and Staff #2 observed child’s eye swell while child was sitting down having breakfast. Records review and statements from interviews conducted concur that facility did not serve any identified child’s allergic food components listed during breakfast on this date.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
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 3


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: WILLIAM R. ANTON EARLY EDUCATION CENTER
FACILITY NUMBER: 197416573
VISIT DATE: 01/18/2023
NARRATIVE
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In review of records, LPA Garcia observed LAUSD Special diet plan for child including medical statement to request special meals signed by Physician on 3/25/22 and request for medication to be taken during school hours (Epipen) signed on 01/11/2023 by the Physician and parent. Staff statements concur the facilities procedures when a student is having allergic reaction is to immediately administer medication (Epipen).

Based on information obtained during this investigation regarding the incident reported, the facility failed to follow all proper procedures. Staff #1 contacted Principal and child’s parent via telephone. Principal contacted 911. Child’s parent arrived at the facility and requested staff to not administer the Epi-pen and instead parent gave child Benadryl. The paramedics arrived at the facility and took child and parent to the Hospital. Child was discharged from the Hospital and has returned to day care. Although facility notified child’s parent, 911 was called, incident report was sent in properly, the facility failed to administer first aid to child therefore, child’s medical needs were not met. Per Principal, all staff training will be conducted to ensure staff follow proper procedures when handling child’s medical needs so that there are no delays in getting medical treatment for any child in need.

The following deficiency listed on the attached LIC 809 deficiencies page is being cited in accordance with California Code of Regulations Title 22.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the facility representative, Cynthia Corcoles.
END OF REPORT: PAGE 2 OF 2.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/18/2023 03:40 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: WILLIAM R. ANTON EARLY EDUCATION CENTER
FACILITY NUMBER: 197416573

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited

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101226-Health-Related Services (c) The licensee shall obtain emergency medical treatment without specific instructions from the child's authorized representative if the authorized representative cannot be reached immediately, or if the nature of the child's illness or injury is such that there should be no delay in getting medical treatment for the child. This requirement is not met as evidenced by:
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Per Principal, all staff training will be conducted to ensure staff follow proper procedures when handling child’s medical needs so that there are no delays in getting medical treatment for any child in need. Principal will send LPA Garcia via email the training agenda, training material & staff sign in sheet on or before POC due date 02/03/2023
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Based on information obtained during this investigation regarding the incident reported, the facility failed to administer first aid to child therefore, child’s medical needs were not met. This poses a potential health and safety risk to children in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2023
LIC809 (FAS) - (06/04)
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