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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417543
Report Date: 06/27/2022
Date Signed: 12/20/2022 08:57:15 AM


Document Has Been Signed on 12/20/2022 08:57 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:A PLACE TWO GROW, INC.FACILITY NUMBER:
197417543
ADMINISTRATOR:CARSON RACHELLEFACILITY TYPE:
840
ADDRESS:3770 SANTA ROSALIA DRIVETELEPHONE:
(323) 295-3114
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:7CENSUS: 0DATE:
06/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rachelle CarsonTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Laureano conducted a Case Management visit and met with Rachelle Carson, director.LPA did not observed any school age children on site during today's inspections.

LPA Laureano explained to the Director Rachelle Carson and discuss the purpose of the visit. Director stated individuals are currently living in the upstairs facility. Based on this information, Gregory Lewis and Christine Edgodawatta do not have a clear criminal record clearance. Review of Guardian associations of Criminal Background clearances reflects individuals as “in process”.

LPA Judy Laureano informed licensee Rachelle Carson, that this report dated 6/27/2022document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Judy Laureano informed the licensee, Rachelle Carson, to provide a copy of this licensing report dated 6/27/2022 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the licensee Rachelle Carson.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
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 12/20/2022 08:57 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: A PLACE TWO GROW, INC.
FACILITY NUMBER: 197417543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2022
Section Cited

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to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (d1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee agrees to ensure all adults living in the unit above facility have a criminal background clearance by 6/27/2022.
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This requirement is not met as evidence by:
Based on interviews, the licensee did not ensure a criminal record clearance was obtain for adults living in the unit above facility, which poses an immediate Health, Safety, or Personal Rights to the 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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 12/20/2022 08:57 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: A PLACE TWO GROW, INC.
FACILITY NUMBER: 197417543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2022
Section Cited

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to Health and Safety Code Section 1596.871 shall prior to working, residing, or volunteering in a licensed facility: (d1) Obtain a California clearance or a criminal record exemption as required by the Department
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Licensee agrees to ensure all adults living in the unit above facility have a criminal background clearance by 6/27/2022.
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This requirement is not met as evidence by:
Based on interviews, the licensee did not ensure a criminal record clearance was obtain for adults living in the unit above facility, which poses an immediate Health, Safety, or Personal Rights to the 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: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3