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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018390
Report Date: 03/01/2024
Date Signed: 03/01/2024 04:09:26 PM


Document Has Been Signed on 03/01/2024 04:09 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
L.A. DAYCARE-NO.WEST, 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: 22DATE:
03/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Adriana Estrada- Lead TeacherTIME COMPLETED:
04:10 PM
NARRATIVE
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 On 03/01/2024 Licensing Prgram Anayst( LPA) Doris Whitmore conducted an unannounced visit for the purpose of conducting a Case Management Inspection due to an incident that occurred and was reported to the Regional Office on 02/23/2024.LPA Whitmore met with Adriana Estrada, Lead Teacher. The Lead Teacher was informed about the purpose of the visit. There was a total of 22 children and six teachers. The reported stated that (S1) had taken six children to the restroom around 10:45 am, When she returned at 10:50 a.m. she accidentally left (C3) in the restroom. The floater (S3)who was delivering the children's lunch went back to the kitchen to get a roll of paper towels. ( S3) was cleaning the tables out side and noticed the child coming from the restroom. ( S3) approached the child and asked if she wanted to hold her hand. ( S3) took the chid back to the classroom.

LPA obtained a copy of the Child Care Facility Roster, Sign in and out sheet for (C3) from 02/13/2024- 02/29/2024. Para los Ninos Child Supervision Record, Education and Early Childhood Development Services Care and Supervision Children, and Unusual Incident Reporting.

Based on the information obtained throughout the course of the investigation, which included interviews with facility staff and children there was a lack of care and supervision due to child being left in the restroom unattended. Also that ( S3) noticed the child coming from the restroom area. ( S1) was in the class already with the other children.
LPA Whitmore conducted exit inter view with Adriana Estrada and explained that the deficiency was a Type A. Please see LIC809D.Licensing Program Anayst( LPA) provided LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled. Also to obtain the parent's signature on form LIC9224, as acknowledgment that they received a copy of this report. Form LIC9224 is to be retained in the child's file.
Copy of report and Notice of Site Visit was issued.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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Document Has Been Signed on 03/01/2024 04:09 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
L.A. DAYCARE-NO.WEST, 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: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/08/2024
Section Cited
CCR
101229(a)(1)

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101229 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,
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Facility will continue to use Numbers when the teachers take the children to the restroom and will write the number on the white board. The teachers will take the number card to the restroom so they will remember the number of the children they took, A video will be sent.
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This requirement was not met as evidence because (C3) was left in the restroom unattended.
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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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
LIC809 (FAS) - (06/04)
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