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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011690
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:04:17 AM

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:ST. ANNE'S EARLY LEARNING CENTERFACILITY NUMBER:
198011690
ADMINISTRATOR:LORNA LITTLEFACILITY TYPE:
850
ADDRESS:151 N. OCCIDENTAL BLVD.TELEPHONE:
(213) 381-2931
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:90CENSUS: 31DATE:
09/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Amanda Velasquez TIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Case Management inspection due to an incident which occurred on 07/16/21. LPA Mora met with Associate Director's Amanda Velasquez and Ruben Tarango. LPA was guided on a walk through of the facility at approximately 9:20 AM with Center Manager Lucy Cervantes and Ruben Tarango.

The incident that occurred on 07/16/21 was reported to the Department on 07/19/21 via telephone. The facility did report the incident in a timely manner.

LPA conducted brief interviews and obtained documentation during this visit. LPA also observed video footage of the incident which occurred.

On 07/16/21, during outdoor play time a child injured his left arm while going down a slide on his tummy. The injury did result in required medical attention. LPA observed video footage which showed that staff were in close proximity and tended to the child immediately after the accident. Based on all information obtained on this date, and interviews conducted with staff, no follow-up is necessary regarding the incident. The incident appears to be an unusual incident.

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.

Exit interview was conducted. Appeal rights were explained and provided.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021
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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