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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416670
Report Date: 10/30/2023
Date Signed: 10/31/2023 09:28:03 AM


Document Has Been Signed on 10/31/2023 09:28 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CASSIDY PRESCHOOLFACILITY NUMBER:
197416670
ADMINISTRATOR:LUISA RIVOSECCHIFACILITY TYPE:
850
ADDRESS:2122 WILSHIRE BOULEVARDTELEPHONE:
(310) 829-5700
CITY:SANTA MONICASTATE: CAZIP CODE:
90403
CAPACITY:84CENSUS: 71DATE:
10/30/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Teru Kurita, Program CoordinatorTIME COMPLETED:
12:20 PM
NARRATIVE
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On 10/30/2023 Licensing Program Analyst (LPA)s Cristina Castellanos and Judy Laureano conducted a case management inspection. LPAs spoke to Teru Kurita, to discuss the purpose of today visit. LPAs toured the inside and outside of the facility and observed: 71 children and 13 staff.

LPA Castellanos received notification from the Department of Public Health of a COVID-19 outbreak at facility on 9/11/2023. LPA Castellanos contacted facility Director Luisa Donati on 9/20/2023 to gather additional details regarding the Covid Outbreak at the facility and what preventative measures that were provided by the Department of Public Health assigned nurse, Ashley Griffin.

Based on document review and interviews, facility did not report incident by telephone or fax within the Department's next working day and during it’s normal business hours. Facility is being cited a Type B citation, please see LIC 809D.

Copy of report and notice of site visit was provided to Teru Kurita, Program Coordinator.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Cristina CastellanosTELEPHONE: 424-301-3097
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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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Document Has Been Signed on 10/31/2023 09:28 AM - 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: CASSIDY PRESCHOOL
FACILITY NUMBER: 197416670

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2023
Section Cited
CCR
101212

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made...
(1) Events reported shall include the following:
(E) Epidemic outbreaks.
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Facility agrees to submit all Unsual Incident Reports to ESRO via email ESROSupportStaff@dss.ca.gov
Correction citation has been cleared.
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This requirement was is not met as eveidenced by:
Facility did not notified the Department of 9/11/23 Covid-19 Outbreak. No documentation - LIC624, and/or telephone call was made to the El Segundo Child Care Regional Office which poses a potential Health and Safety risk to the person 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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Cristina CastellanosTELEPHONE: 424-301-3097
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
LIC809 (FAS) - (06/04)
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