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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198015784
Report Date: 07/19/2023
Date Signed: 07/19/2023 04:44:02 PM


Document Has Been Signed on 07/19/2023 04:44 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:OPTIONS EARLY HEAD START - LA SEDAFACILITY NUMBER:
198015784
ADMINISTRATOR:RUBY SEVILLAFACILITY TYPE:
830
ADDRESS:18410 RENAULT STREETTELEPHONE:
(626) 581-4049
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:49CENSUS: 10DATE:
07/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Vinia CasugaTIME COMPLETED:
05:00 PM
NARRATIVE
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On 7/19/2023 at 9:30 am, Licensing Program Analyst (LPA) Carolyn Tuba conducted an unannounced case management inspection to follow up on an Unusual Incident reported on 5/19/2023. LPA met with Andrea Uribe, Site Director who provided a tour of the facility to gain the census. There were 10 children and 5 staff present during the inspection. During the inspection Site Director called Education Coordinator (EC), Vinia Casuga who met LPA at the facility at approximately 10:30 am.

The incident that occurred on 05/19/2023 was reported to the Department on 05/19/2023 via email on a written Unusual Incident Report (UIR) provided to Community Care Licensing. The facility reported the incident in a timely manner. LPA conducted interviews with Education Coordinator, Staff #1 (S1) and #2 (S2). An additional staff member who was present during the incident was not available to interview, as they are currently at another facility and was subbing that day.

The Unusual Incident reported concerns of a child wandering away from the facility at approximately around 10:50 am and wandered off onto a field of a school located next door to the facility. After LPA conducted interviews with Education Coordinator, S1, and S2, it was disclosed that child wandered away from a back gate that is typically locked but on that day was left open by an unidentified person. Based on EC, S1 and S2 child was gone no longer then 3 to 5 minutes and was found by a staff member from the school next door. EC, S1 and S2 stated that there is a protocol to count children during transitions, to count every 10 to 15 minutes inside/outside, to document on a white board the ratio of children and a count is taken when a staff member leaves the area. On that day S2 left the playground area where children were playing, and the facility was in staff to children ratio, confirmed by a second staff member, but when S2 returned the ratio of children had changed. When staff realized the a child was missing, the staff member from the school next door notified staff of the child who had wandered away. Both EC and S1 confirmed that S2 was not present and that the child was approximately gone for 5 minutes based on the events of that morning. Principal of the school next door informed EC of the event that occurred. Parent of the child was notified of the incident.
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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023
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 07/19/2023 04:44 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: OPTIONS EARLY HEAD START - LA SEDA
FACILITY NUMBER: 198015784

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2023
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, except as specified in Sections.......
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Per Education Coordinator, Staff has been provided ‘training and supervision modules and protocols have been implemented. Education Coordinator agrees to provide LPA copies of forms that staff signed confirming that supervision trainings were implanted and will be sent to LPA via email.
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This requirement is not met as evidenced by: Based on interviews, the child wandered away from the facility unsupervised for at least 5 minutes with no adult supervision. This poses an immediate Health and Safety 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: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2023
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: OPTIONS EARLY HEAD START - LA SEDA
FACILITY NUMBER: 198015784
VISIT DATE: 07/19/2023
NARRATIVE
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Child was not interviewed due to age of the child. EC conducted their own internal investigation. According to EC, S1 and S2 protocols of supervision have changed due to the incident. Children now play in enclosed playground instead of the open playground where children played previously, all staff check to make sure gates are locked in the morning and before taking children out to play, additional training of Care and Supervision have been given and head count protocols (counting before and after outside play, every 15 minutes head count and log on head count log sheet and counting when staff leave and staff return to the area. When staff enters the classroom, they announce that the door is open and count the children.

The following deficiency listed on the attached LIC 809 (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

One (1) Type A - 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 form must be maintained in each child’s file immediately upon receipt from parent. Licensee/Director was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.

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 conducted, appeal rights given, and a copy of the report was reviewed and given to Education Coordinator, Vinia Casuga

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SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Carolyn TubaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 07/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023
LIC809 (FAS) - (06/04)
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