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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198008125
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:29:36 PM


Document Has Been Signed on 06/23/2023 02:29 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:PICO UNION PRESCHOOL CENTER/PARA LOS NINOSFACILITY NUMBER:
198008125
ADMINISTRATOR:ANGELA CAPONEFACILITY TYPE:
850
ADDRESS:1521 W. THIRD ST.TELEPHONE:
(213) 250-4800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90017
CAPACITY:72CENSUS: 0DATE:
06/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Cesia Romero TIME COMPLETED:
02:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 05/26/23. LPA met with Site Supervisor, Cesia Romero. LPA observed that no children were present during the time of inspection. LPA conducted interviews with staff and obtained documentation during this visit.

The incident that occurred on Friday May 26, 2023 was reported to the Department on Tuesday May 30, 2023 via email. The facility did report the incident in a timely manner as May 29, 2023 was a legal holiday.

On May, 26, 2023 at approximately 11:30 AM C1 was left unattended by staff. Child was left outside of the classroom (Room 61) in the playground walkway. Disclosures were made verifying that the incident did occur. Disclosures were consistent. Title 22 Regulation Section10101229(a)(1) states, Responsibility for Providing Care and Supervision, no child(ren) shall be left without the supervision of a teacher at any time, supervision shall include visual observation. This was an immediate risk to the health and safety of the child 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 of this report to the parents of children enrolled and to any parents of newly enrolled children in care for up to one year. Parents are required to sign the LIC 9224 Acknowledgement of Receipt of Licensing Reports, and a copy must be placed in children's files. A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.


*REPORT CONTINUES ON NEXT PAGE
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
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 06/23/2023 02:29 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: PICO UNION PRESCHOOL CENTER/PARA LOS NINOS
FACILITY NUMBER: 198008125

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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Site Supervisor states she conducted a training with staff on June 1, 2023. Staff provided LPA with a copy of the powerpoint used and staff sign in.
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except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by the incident that occurred on 05/26/23. C1 was left unattended by staff. Child was left outside of the classroom (Room 61) in the playground walkway. Disclosures were made verifying that the incident did occur. Disclosures were consistent. This was an immediate risk to the health and safety of the child 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 GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2023
LIC809 (FAS) - (06/04)
Page: 2 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: PICO UNION PRESCHOOL CENTER/PARA LOS NINOS
FACILITY NUMBER: 198008125
VISIT DATE: 06/23/2023
NARRATIVE
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The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during 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.

The deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

Deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Exit interview was conducted with Cesia Romero. Appeal rights explained & provided.




*END OF REPORT
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3