198016996-9-7-2021-33-CC-JMOA-C6MTJK-20210907144629

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198016996
Report Date: 09/07/2021
Date Signed: 09/07/2021 02:46:36 PM

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:	UNION STATION GATEWAY CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	198016996
ADMINISTRATOR:	CYNTHIA RIDING		FACILITY TYPE:	830
ADDRESS:	1 GATEWAY PLAZA 99-PL-7		TELEPHONE:	(213) 922-4453
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90012
CAPACITY:	24	CENSUS: 15	DATE:	09/07/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:26 PM
MET WITH:	Shaquiesha Hampton,		TIME COMPLETED:	03:10 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	Licensing Program Analyst (LPA) conducted a case management inspection due to an incident that occurred at the facility on 03/27/2019. LPA met with Director, Shaquiesha Hampton, who guided LPA on a tour of the facility at approximately 12:40 PM. LPA conducted interviews and obtained documentation during this visit. The incident that occurred on 03/27/19 was never reported to the Department. LPA observed the incident documented on an Employee Written Warning form in a Staff file that was being reviewed on 08/30/21 during an Annual Required inspection. The facility was aware of the incident on the day it occurred. The facility is being cited for failure to report this incident to the Department within the required 24 hours. During the course of this inspection LPA observed a staff write up with the description of the incident which occurred. Disclosures were made in regards to the incident. LPA found that a child was left unsupervised for approximately 5 minutes in the indoor/outdoor playground. A staff realized a child was missing and the child was then found on the playground. Title 22 Regulation Section 101229 states that "No child(ren) shall be left without the supervision of a teacher at any time, Supervision shall include visual observation." This was an immediate risk to the health and safety of the child in care. Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the Director will also provide copies to the parents of the children in care for up to one year. *REPORT CONTINUES ON NEXT PAGE

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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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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: UNION STATION GATEWAY CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198016996
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/09/2021 Section Cited	1 2 3 4 5 6 7	Responsibility for Providing Care and Supervision No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by
	8 9 10 11 12 13 14	a staff write up and staff disclosure. A child was left alone for approximately 5 minutes in the indoor/outdoor playground. This was an immediate risk to the health and safety of the child in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

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: UNION STATION GATEWAY CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198016996
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/08/2021 Section Cited	1 2 3 4 5 6 7	Reporting Requirements Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
	8 9 10 11 12 13 14	In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement was not met as evidenced by LPA observing that an incident which occurred at the facility on 03/27/2019 was never reported to the Department. This is a potential risk to the health and safety of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 4

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: UNION STATION GATEWAY CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 198016996
	VISIT DATE: 09/07/2021

NARRATIVE

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A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

LPA advised the licensee how to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

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.

The deficiencies listed on the following pages were observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

Exit interview was conducted with Director. Appeal rights explained & provided.

*END OF REPORT

SUPERVISOR'S NAME: Claudia Guangorena	TELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy Mora	TELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021

LIC809 (FAS) - (06/04)

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