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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 06/07/2019
Date Signed: 06/17/2019 07:10:32 AM

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:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:TELMA CEAFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:55CENSUS: DATE:
06/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
07:15 AM
MET WITH:Telma CeaTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Silva Garibyan arrived at the above facility to conduct a Case Management Incident inspection. The self - reported incident occurred at CII South Vermont Site on 05/08/19. The El Segundo Regional Office received the incident report on 05/09/19. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

" Staff #1 allegedly observed Staff #2 put both hands on Child #1's arms and shook child as Staff #1 said " you need to stop", in a firm tone of voice."


LPA interviewed the site supervisor, two teachers, one assistant, the family service worker, and four children. Based upon the evidence obtained through the course of investigation which include observations at the facility, interview with relevant parties, and records review, we have concluded there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, this allegation has been determined unsubstantiated.



The content of this report was read and discussed in detail at the time of the visit with the site supervisor.

An exit interview was conducted; the Notice of Site Visit must be posted for 30 days upon receipt.

SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2019
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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