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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014885
Report Date: 07/15/2022
Date Signed: 07/15/2022 04:18:02 PM


Document Has Been Signed on 07/15/2022 04:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:UNIQUE'S PRESCHOOLFACILITY NUMBER:
198014885
ADMINISTRATOR:LETICHA TONEYFACILITY TYPE:
850
ADDRESS:9322 S. MAIN STREETTELEPHONE:
(323) 779-2595
CITY:LOS ANGELESSTATE: CAZIP CODE:
90003
CAPACITY:25CENSUS: 15DATE:
07/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Johnnie McWilliams Johnson, Facility AdministratorTIME COMPLETED:
04:30 PM
NARRATIVE
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On 07/15/2022, Licensing Program Analyst (LPA) Katrina Chicote arrived at facility for the purpose of delivering findings to complaint inspection. Upon arrival, LPA observed A1 singularly providing care to 15 children (12 napping). LPA did not observe A1 on clearance sheet.

Facility Administrator, Johnnie McWilliams Johnson, arrived at facility after five minutes and stated that she was just using the restroom. LPA notified her of A1 not being cleared. Facility Administrator states that A1 is a volunteer. LPA notified Facility Administrator of clearance requirements and that volunteers cannot be left alone to provide care for children. This is a violation of Title 22 regulation requirements and poses an immediate health, safety, and personal rights risk to children in care and a civil penalty assessed.

Licensee (or facility representative) was reminded that all adults 18 and over living or working in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed facility. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Johnnie McWilliams Johnson.
Report Ends - Page 1 of 1

SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 07/15/2022 04:18 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 CENTER DR 200B
MONTEREY PARK, CA 91754


FACILITY NAME: UNIQUE'S PRESCHOOL
FACILITY NUMBER: 198014885

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2022
Section Cited

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102416(d) Personnel Requirements Prior to employment or initial presence in the child care..all employee...shall: (1) Obtain a California clearance..exemption as required by law or Department regulations...
This regulation was not met as evidenced by:
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Based on LPA observations and interview, A1 was singularly providing care to 15 children (12 napping). Interview with Facility Administrator cofirms A1 was left alone. This poses an immediate health, safety, and personal rights risk to 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: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
LIC809 (FAS) - (06/04)
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