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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018390
Report Date: 04/07/2022
Date Signed: 04/07/2022 12:20:38 PM


Document Has Been Signed on 04/07/2022 12:20 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:PARA LOS NINOS HEAD START MAGNOLIAFACILITY NUMBER:
198018390
ADMINISTRATOR:ELVIA CLAVESILLAFACILITY TYPE:
850
ADDRESS:2828 W. MAGNOLIA BLVDTELEPHONE:
(818) 333-4725
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:45CENSUS: 42DATE:
04/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Yesenia Portillo, TeacherTIME COMPLETED:
12:30 PM
NARRATIVE
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On April 7, 2022 at 10:00AM, Licensing Program Analyst (LPA) Meghan McGee conducted an unannounced visit to the facility to conduct a Case Management on a self reported incident that occurred on 3/22/2022. Upon arrival, LPA met with Yesenia Portillo, Teacher and informed the nature of the visit. There was a total of 42 children being supervised by 9 staff.

The El Segundo Regional Office received an Unusual Incident/ Injury report on 3/22/2022. The report stated that Child 1 (C1) was accidentally left by their self in the children’s restroom. Staff 1 (S1) had taken 4 children to the restroom and C1 was the last child to use the restroom in the 3rd stall. While dealing with a challenging child, S1 forgot to count the children and took 3 children back to the classroom. Within less than a minute, S1 realized C1 was left in the bathroom. As S1 turned around, Staff 2 (S2) was bringing C1 to the classroom.

Based on available evidence, observations, and interviews conducted there was a lack of care and supervision due to child being left in the bathroom unattended.

LPA McGee conducted exit interview with Yesenia Portillo, Teacher and report was provided with noted deficiency on LIC809D in accordance with the California Code of Regulations, Title 22. Facility was cited a type A deficiency for lack of care and supervision.

Licensee was provided form LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled and to obtain the parent's signature on form LIC9224, as acknowledgement that they received a copy of this report.



Copy of report and Notice of Site Visit issued.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Meghan McGeeTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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 04/07/2022 12:20 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: PARA LOS NINOS HEAD START MAGNOLIA
FACILITY NUMBER: 198018390

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/06/2022
Section Cited

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101229 Responsibility for providing care and supervison (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 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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Based on observations and interviews, Staff 1 (S1) left Child 1 (C1) unattended in the bathroom, which poses an immediate health and safety issue to persons 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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Meghan McGeeTELEPHONE: (424) 301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
LIC809 (FAS) - (06/04)
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