198020296-8-25-2021-33-CC-LGOZ-C68T64-20210825142632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020296
Report Date: 08/25/2021
Date Signed: 08/25/2021 02:26:43 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 EARLY HEAD START: VINE		FACILITY NUMBER:	198020296
ADMINISTRATOR:	ANGELA CAPONE		FACILITY TYPE:	830
ADDRESS:	1147 VINE ST		TELEPHONE:	(213) 250-4800
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90038
CAPACITY:	18	CENSUS: 13	DATE:	08/25/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:41 AM
MET WITH:	Carla Torres, Area Supervisor		TIME COMPLETED:	02:45 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	At 11:41AM an unannounced in-person Case Management-Incident inspection was conducted by Licensing Program Analyst (LPA) Lissete Gonzalez to follow up on an Unusual Incident. The incident was self-reported via telephone on 08/03/2021 and via fax on 08/09/2021 to Community Care Licensing. It was reported to the Department that the incident occurred at the facility on 7/21/2021. Upon LPA's arrival to the building at 11:41AM, LPA Gonzalez was greeted and let into the facility by Area Supervisor, Carla Torres. Also present was Early Head Start (EHS) Education in Training Coordinator, Rosalia Jimenez-Chavez. The purpose of the inspection was announced. Area Supervisor guided LPA on a tour of the facility. Census was taken. The following staff were present during this inspection: Room 81: Staff #3, and 04 sleeping infants; Room 82: Staff #4 and Staff #5 and 3 sleeping infants; Room 83: Staff #6 and Staff #7 and 6 sleeping infants. The Unusual Incident reported concerns of a possible violations of the Personal Rights of a infants in care in Room 81 by Staff #8 and Staff #9. Staff #8 and Staff #9 were not present during this visit. During today's inspection, LPA obtained documentation including the children’s roster and interviews were conducted with staff. Staff disclosures corroborated the allegations that children in Room 81 were subjected to Staff #6 and Staff #7’s interference with children's sleeping and diapering needs. In addition, children sat at tables after meals for extended periods of time. Video footage of Room 81 was no longer available for review during this visit. Area Supervisor states the video footage is stored for 3 weeks only and is automatically deleted thereafter. Based upon information received from interviews conducted it was determined that the personal rights of children in care in Room 81 were violated by Staff #8 and Staff #9. This poses a potential risk to the health and safety of children in care. REPORT CONTINUES ON NEXT PAGE: 1 OF 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

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 EARLY HEAD START: VINE	FACILITY NUMBER: 198020296
	VISIT DATE: 08/25/2021

NARRATIVE

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LPA obtained documentation confirming Staff #8 and Staff #9 were terminated on 8/13/2021. In addition, LPA reviewed sign-in sheets and training materials documenting that facility staff attended a Professional Development day on 8/13/2021. Topics covered included Personal Rights, Diaper Changing/Toileting, and Care & Supervision. Based on information provided, LPA cleared the deficiency cited during today’s visit.
A printed copy of this report and appeal rights (LIC 9058) was provided to Area Supervisor, Carla Torres, 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.

END OF REPORT PAGE: 2 OF 2

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 EARLY HEAD START: VINE	FACILITY NUMBER: 198020296
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/25/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/26/2021 Section Cited	1 2 3 4 5 6 7	Personal Rights - To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing,
	8 9 10 11 12 13 14	medication or aids to physical functioning. This requirement was not met as evidenced by: During interviews, staff disclosures corroborated the allegations that the personal rights of children in Room 81 were violated by Staff #8 and Staff #9. This poses a potential risk to the health and safety of childrenin 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: Christina Gabelman	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR NAME: Lissete Gonzalez	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2021

LIC809 (FAS) - (06/04)

Page: 3 of 3