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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570895
Report Date: 11/14/2024
Date Signed: 11/14/2024 03:26:58 PM

Document Has Been Signed on 11/14/2024 03:26 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
MONTEREY PARK SW RO, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LINDBERGH FULL DAYFACILITY NUMBER:
191570895
ADMINISTRATOR/
DIRECTOR:		VERONICA BLOOMFIELDFACILITY TYPE:
850
ADDRESS:12120 LINDBERGH ROADTELEPHONE:
(310) 631-7308
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 38DATE:
11/14/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:21 PM
MET WITH:Gisele Ochoa-Education SpecialistTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Jeanette Estrada and Keneisha Dunlap conducted an unannounced case management inspection at the facility. The purpose of this inspection is to issue a type A deficiency for a violation of criminal record clearance. LPAs met with Gisele Ochoa-Education Specialist and explained the reason for the visit. There were 15 children with 4 staff in bungalow 14 and 23 children with 3 staff in classroom T-11.
Today, LPAs initially conducted a case management visit at this facility for the purpose of investigating an unusual report that was submitted to the Department on 11/1/24 (see LIC 809 Case Management-Incident). During the review of criminal record clearances for staff in bungalow 14, there was no clearance available for Staff 1. LPAs were advised Staff 1 is a substitute from Swing Education and has been present for 1 day. LPAs reviewed Guardian which revealed no results for Staff 1. LPAs advised Facility Representative that Staff 1 cannot be present without a criminal record clearance. At approximately 1PM, Staff 1 was removed from the classroom. Facility Representative attempted to contact the substitute agency to obtain the required documentation for Staff 1 to prove they have a clearance through the Department (LIC 9163 Request for Livescan Service) but was unsuccessful as agency could not provide proof.
The deficiency listed on the following page were observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. One type A citation and a civil penalty of $100 was issued today for CCR 102370(d)(1) Criminal Record Clearance . Please see attached LIC 809-D for citation.
The notice of site visit shall be posted where the parent/guardian of children enter and exit the facility. A copy of this report shall also be posted where the parent/guardian of children enter and exit the facility. Both the notice of site visit and licensing report shall remain posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt. Exit interview conducted and report was reviewed with the Facility Representative, Gisele Ochoa-Education Specialist. A copy of the report and the Notice Of Site Visit were provided.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Jeanette Estrada
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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 11/14/2024 03:26 PM - It Cannot Be Edited


Created By: Jeanette Estrada On 11/14/2024 at 01:42 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
Section Cited
CCR
102370(d)(1)

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102370(d)(1)Criminal Record Clearance:
All individuals subject to a criminal record review...shall prior to working... in a licensed facility:Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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1. Facility Representative had Staff 1 removed from the classroom.
2. Facility Representative will contact the substitute agency to ensure that Staff 1 obtains a fingerprint clearance using form LIC 9163 before returning to the facility.
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 Based observation and record review LPAs observed Staff 1 providing care and LPAs reviewed Guardian where it was revealed Staff 1did not have a criminal record clearance through the Department.This poses an immediate safety or personal rights risk to persons in care.
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3. Per Facility Representative, a plan to ensure compliance with criminal record clearances for substitutes will be created and submitted to the Department.

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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:Karen Chambers
LICENSING EVALUATOR NAME:Jeanette Estrada
LICENSING EVALUATOR SIGNATURE:
DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/14/2024


LIC809 (FAS) - (06/04)
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