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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191603677
Report Date: 04/22/2022
Date Signed: 04/22/2022 03:13:17 PM

Document Has Been Signed on 04/22/2022 03:13 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:HOLY TRINITY LUTHERAN CHILD CARE CENTERFACILITY NUMBER:
191603677
ADMINISTRATOR:KORY HIGGINSFACILITY TYPE:
850
ADDRESS:9300 CRENSHAW BLVDTELEPHONE:
(323) 757-4850
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY: 85TOTAL ENROLLED CHILDREN: 35CENSUS: 27DATE:
04/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:24 PM
MET WITH:Zenaida Ontiveros, StaffTIME COMPLETED:
03:25 PM
NARRATIVE
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On 04/22/22 Licensing Program Analyst (LPA) Shandra Powell conducted a Case Management Other inspection due to an observation made during a walk-through of the facility while investigating a complaint. LPA observed teacher aide caring for 3 toddler children at tables in classroom alone.

Toddler Teacher was observed returning to the classroom within 10min during inspection, however This poses an potential risk to the health and safety of the children in care.

An aide shall work only under the direct supervision of a teacher.


The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.


An exit interview was conducted and a copy of this report, appeal rights and notice of site visit was given to Ms. Ontiveros, Teacher.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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 04/22/2022 03:13 PM - It Cannot Be Edited


Created By: Shandra Powell On 04/22/2022 at 02:48 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HOLY TRINITY LUTHERAN CHILD CARE CENTER
FACILITY NUMBER: 191603677

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2022
Section Cited
CCR
101216.2(e)

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An aide shall work only under the direct supervision of a teacher.

(1) An aide who is 18 years of age or older, and who meets the
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Corrected at time of visit when a teacher arrived.
Licensee to contact LPA Powell by Email and present a written plan to ensure that a teacher is supervising an aide/assistant so that the aide/assistant is not left alone by POC date of 04/25/2022
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requirements of this section and Section 101216, may escort and/or assist children in going to the bathroom, and may supervise napping children as specified in Section 101230(c)(1), without being under the direct supervision of a teacher.
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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 Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022


LIC809 (FAS) - (06/04)
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