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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370896
Report Date: 02/20/2020
Date Signed: 02/20/2020 02:47:37 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:EARLY LEARNING PRESCHOOLFACILITY NUMBER:
304370896
ADMINISTRATOR:MARTINEZ, CHRISTAFACILITY TYPE:
850
ADDRESS:4539 CERRITOS AVENUETELEPHONE:
(562) 493-3921
CITY:CYPRESSSTATE: CAZIP CODE:
90630
CAPACITY:68CENSUS: 46DATE:
02/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Director Martinez Christa TIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst Ketki Desai, conducted an unannounced Case Management inspection following an incident reported by the facility.
Child # 1 was a new enrollment to the facility beginning 2-3-2020. On 2-12-20 authorized representative dropped off child#1, in the morning and returned back for an observation around lunch time(11.30 am). As the lunch was being served, to child # 1,It was observed by the authorized representative that child#1, was served a food item on plate, which was listed as an allergic item on LIC 702 and LIC 627. Authorized representative immediately alerted the staff about the food item being served, is an allergic item, to which the staff member remained unaware. Child # 1 was dis-enrolled on the same day.
Licensing Program Analyst met with the Director on site, discussed the incident and reviewed the enrollment packet. LPA noted on LIC form 702 and LIC 627 the item served to Child # 1 was listed and signed by the Authorized representative.
Facility Director failed to take notice of the allergy item documented on LIC 702 and LIC 627. Facility Allergy list posted in each classroom was not updated and the teaching staff were also not aware of the Child # 1’s allergic items listed on LIC 702 and LIC 627.

Based on LPA's observations, interviews conducted the preponderance of evidence standard has been met, Facility failed to meet the needs of the child in care and served an item listed as an Allergic item on LIC 702 and LIC 627 which poses an immediate risk to Health and Safety

California Code of Regulations, Title 12, Division 22 Section 101227 (7) (B) is being cited for Food Services

SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: EARLY LEARNING PRESCHOOL
FACILITY NUMBER: 304370896
VISIT DATE: 02/20/2020
NARRATIVE
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If the facility receives a Type A violation, the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days and provide a copy to current and enrolling parents. The licensee is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.

Exit interview was conducted. The report was reviewed and discussed.
Appeal Rights discussed and provided to the facility Director.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post Type A reports for 30 days will result in a Civil Penalty of $100.00.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2020
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: EARLY LEARNING PRESCHOOL
FACILITY NUMBER: 304370896
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/24/2020
Section Cited

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Food Services: A child shall not be served any food to which the child's record indicates he/she has an allergy.
The above requirement is not met by evidence of facility serving an allergic item (Egg) to Child #1 during lunch time and the Item was listed on LIC 702 & 627, which was received upon admission by the
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facility and the allergy list posed in
each classroom was not updated and none of the teaching staff were aware of it.
This poses an immediate risk to Health and Safety to 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: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Ketki DesaiTELEPHONE: (714) 743-8635
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2020
LIC809 (FAS) - (06/04)
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