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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198012158
Report Date: 02/15/2024
Date Signed: 02/15/2024 12:06:56 PM


Document Has Been Signed on 02/15/2024 12:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CHILDREN'S ACADEMY OF SUCCESSFACILITY NUMBER:
198012158
ADMINISTRATOR:SINTTIA BECERRAFACILITY TYPE:
850
ADDRESS:10839 LA REINA AVENUETELEPHONE:
5622314373
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:48CENSUS: 53DATE:
02/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Bianca SigalaTIME COMPLETED:
12:20 PM
NARRATIVE
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While conducting an investigation for a complaint, Licensing Program Analysts (LPAs), T. Tran and A. Padilla observed the following deficiencies:

During today's visit, LPAs completed record review of the parent's signing in and out and observed 38 signature and 15 children were not signed in for the total of 53 were present. LPAs discussed with the facility representative that the facility is currently operating over the licensed capacity. During the visit, LPAs observed center staff took action immediately by sending 5 children home in order to maintain compliance with the department.

Upon receipt of a Type A deficiency, licensee shall post and provide copies of this licensing report to parent/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Copies of the reports must also be provided to each parent when a serious deficiency, Type A, is cited. If a serious violation is cited, a copy of the licensing report LIC809 and LIC 809D must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed.

Facility was cited for type A and Type B deficiency. See Facility Evaluation Report LIC 809D for deficiency cited.

A notice of site visit was given and must remain posted for 30 days.


Exit interview conducted and report was reviewed with the facility representative, Bianca Sigala.
SUPERVISOR'S NAME: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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 02/15/2024 12:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: CHILDREN'S ACADEMY OF SUCCESS
FACILITY NUMBER: 198012158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2024
Section Cited
CCR
101161(a)

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Limitations on Capacity
This requirement is not met as evidenced by
based on record review facility failed to maintain the license capacity by operating over 5 children during today's visit.
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Center director shall submit a written statement informing the dept. what action will be taken to avoid being over capacity. Licensee will also submit a schedule listing the days and times of each part time children in care by the due 2/23/24.

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2/15/24, LPAs observed 53 children were present and the faciity was license to operate 48 children which poses an immediate health and safety risk to children in care.
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LPA observed 5 children were picked up during today's visit.

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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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/15/2024 12:06 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: CHILDREN'S ACADEMY OF SUCCESS
FACILITY NUMBER: 198012158

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/23/2024
Section Cited
CCR
101229.1(a)(1)

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Sign In and Sign Out
This requirement is not met as evidenced by
based on record review facility failed to obtain 5 parent's signature upon dropping off the children which poses a potential health and safety risk to children in care.
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Center director shall submit a written statement informing the dept. what action will be taken to monitor the parents sign in and out and the complete parent's signature for children's attendance on 2/215/24 then submit to the department by the due 2/23/24.

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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: Denise GibbsTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3