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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007140
Report Date: 03/24/2023
Date Signed: 03/24/2023 04:37:14 PM


Document Has Been Signed on 03/24/2023 04:37 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CHILDREN'S COLLECTIVE - THE INFANT TODDLERFACILITY NUMBER:
198007140
ADMINISTRATOR:JEANETTE BANUELOSFACILITY TYPE:
830
ADDRESS:932 W. 85THTELEPHONE:
(323) 789-1873
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:19CENSUS: 12DATE:
03/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:48 PM
MET WITH:Shawna Mizell, Education SpecialistTIME COMPLETED:
04:30 PM
NARRATIVE
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 Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced Case Management Incident inspection for the above facility. The El Segundo Child Care Regional Office received the incident report on 03/24/2023 regarding a Infant child being left on the play yard alone with out any supervision including visual supervision for approximately 10 mins. During inspection LPA observed 5 infants and 7 toddlers napping. LPA met with Shawna Mizell, Educational Specialist.

Based on the information obtained and review of the pre recorded video taken on the day in questioned and staff disclosures the facility is cited for Lack of Supervision as no child shall be left without supervision (including visual observation) of a teacher at any time. This is an immediate risk to the health and safety to the children in care.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to parents of the children in care for up to one year. LIC 9224 - Acknowledgement of Receipt of Licensing Report was explained and provided. Appeal Rights were explained. The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Shawna Mizell, Educational Specialist. This report, Appeal Rights and Notice of Site Visit were given.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
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 03/24/2023 04:37 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: CHILDREN'S COLLECTIVE - THE INFANT TODDLER
FACILITY NUMBER: 198007140

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/27/2023
Section Cited

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
No child(ren) shall be left without
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the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
On 03/17/23 a infant child was left alone outside on the play yard for approx. 10 Mins alone. Staff #3 saw the Infant was not in the classroom and mentioned it to Staff#2 who then went outside to retreive the non mobile infant child and bring into classroom.
This is an immediate risk to the health and safety 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: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 03/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/24/2023
LIC809 (FAS) - (06/04)
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