198015308-3-8-2024-54-CC-KCHE-D36UBT-20240308142653

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198015308
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:27:09 PM

Document Has Been Signed on 03/08/2024 02:27 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:	WEST SIDE		FACILITY NUMBER:	198015308
ADMINISTRATOR:	LETICIA RICO NUNEZ		FACILITY TYPE:	850
ADDRESS:	9200 STATE STREET		TELEPHONE:	(323) 563-0067
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	80	CENSUS: 59	DATE:	03/08/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Michelle Aniz, Facility Representative (FR)		TIME COMPLETED:	03:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/08/2024 at 1:30 PM Licensing Program Analysts (LPAs) Katrina Chicote and Anthony Padilla conducted an Unannounced Case Management Inspection to follow up on several incidents that was reported to The Department. Upon arrival, LPAs announced purpose of visit and was allowed entry by Office Administrators. Per Office Administrators, Site Supervisor was not available. Facility Representative (FR) Michelle Alaniz, Child Development Supervisor, later joined inspection. LPAs singularly toured facility at time of inspection. The facility reported all incidents to the Department within the required 24 hours and submitted a written report within seven days, per Title 22 Regulation requirements. On 01/31/2024 an unusual incident report was made to The Department regarding an incident that involved a child sustaining an injury requiring medical attention. Per LIC624 submitted, a child was riding a bicycle and crashed onto a fence which resulted in the child falling off the bike. First Aid was administered to child but child was still crying and Authorized Representative was called and child was picked up and taken to the Doctor and a cast was placed on child's arm. LPAs observed child present during today's inspection with no cast. LPAs observed outdoor play area where incident took place and observed a bicycles well maintained with concrete bike path surface also maintained for activities. LPAs interviewed Teacher named in report, who observed incident, and she confirms having observed the incident and applying first aid. Teacher stated that she did not observe any physical injury besides redness to where the bicycle handle hit the child. Teacher stated she noticed child continued to cry, which is unlike him, so Authorized Representative was called. Based on interviews, and observations made during this inspection, physical plant observed maintained for activities planned, interviews of staff are consistent with report and there was full supervision during incident. LPAs obtained copy of doctor's note during inspection clearing child to return with restrictions on 02/29/2024. Report Continues - Page 1 of 2

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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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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: WEST SIDE	FACILITY NUMBER: 198015308
	VISIT DATE: 03/08/2024

NARRATIVE

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On 02/08/2024, an unusual incident report was made to the department regarding an outbreak of seven cases of hand, foot, and mouth (HFM). Per LIC624 submitted, a written report was provided to parents to notify them of exposure, facility was sanitized, and LA County Department of Health was notified. LPAs observed postings on classroom doors at time of today's inspection as well as DPH Letter dated 02/02/2024 confirming partnership. LPAs observed cleaning and sanitation supplies through out facility as well postings on washing hands in restrooms and sinks in classroom. LPAs observed children transitioning from outside playtime being provided hand sanitizer spray as they were walking in and observed children being dropped off to be told to wash hands by staff upon arrival to facility. Based on the information obtained, there are adequate supplies at facility and an adequate response to incident was made.

The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today, 03/08/2024.

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

Exit interview was conducted and report was reviewed with the Facility Representative, Michelle Aniz.

Report Ends - Page 2 of 2

SUPERVISOR'S NAME: Denise Gibbs	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC809 (FAS) - (06/04)

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