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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018225
Report Date: 05/02/2019
Date Signed: 05/02/2019 12:04:16 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:PARA LOS NINOS HEAD START - HOLLYWOODFACILITY NUMBER:
198018225
ADMINISTRATOR:ANGELA CAPONEFACILITY TYPE:
850
ADDRESS:5000 HOLLYWOOD BLVDTELEPHONE:
(213) 250-4800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY:60CENSUS: 51DATE:
05/02/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Christopher RodriguezTIME COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Lissete Gonzalez and Crystal Green conducted an unannounced case management inspection to follow up on an incident that was reported to the Department. Upon arrival, LPAs met with Head Teacher, Carla Torres and Education Coordinator, Christopher Rodriguez. Christopher Rodriguez provided LPAs a tour of the facility inside and outside. Education Coordinator, Christopher Rodriguez was present for the remainder of the inspection. Census was taken.

On 04/23/19, an unusual incident report was made to the department regarding an incident that involved a child being left alone in the outdoor playground. The facility reported this incident to the Department within the required 24 hours. During this investigation LPAs observed the outside play areas and indoor classrooms and conducted interviews with staff members. LPAs observed the premises both indoor and outdoors to be secured by exterior coded door locks and high fencing surrounding the outdoor playgrounds. LPAs also observed the indoor classrooms to have protocols in place for ratio and head counts however, a child was left unattended on 4/23/19 during transitioning from the outside playground to the indoor classroom by a substitute teacher. LPAs obtained documentation relating to the incident. Based on the information obtained, LPAs determined there was a lack of supervision that resulted in the child being left alone in the outdoor playground which poses a potential risk to the health and safety of the children in care.

California Code of Regulations, Title 22, Division 12, are being cited on the attached LIC 809D.

A printed copy of this report and appeal rights (LIC 9058) was provided to Education Coordinator, Christopher Rodriguez, at the conclusion of the visit and their signature on this form acknowledges receipt of these forms.

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.
SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
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: PARA LOS NINOS HEAD START - HOLLYWOOD
FACILITY NUMBER: 198018225
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2019
Section Cited
CCR
101229(a)(1)
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No child shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.

This requirement was not met as evidenced by: a child was left unattended during transitioning period from the outside
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Per Education Coordinator, facility will send their protocol for head counting and child ratios to Child Care Careers for potential substitutes to review prior to working at facility. Will submit documentation by POC due date of 5/23/2019.
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playground to the indoor classroom by a substitute teacher. This poses a potential risk to the health and safety of the 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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Lissete GonzalezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2019
LIC809 (FAS) - (06/04)
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