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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609574
Report Date: 12/08/2022
Date Signed: 12/09/2022 01:03:29 PM

Document Has Been Signed on 12/09/2022 01:03 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:CHILDREN COMMUNITY ACADEMYFACILITY NUMBER:
191609574
ADMINISTRATOR:ETHEL L. HENSONFACILITY TYPE:
850
ADDRESS:4729 W. SLAUSON AVE.TELEPHONE:
(323) 290-0022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 30DATE:
12/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Wymon Henson & Nori Henson TIME COMPLETED:
06:30 PM
NARRATIVE
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On December 8, 2022, Licensing Program Analyst (LPA), V. Wheatley conducted a case management. LPA was greeted by Staff #1 Nori Henson who was observing parents sign their children out today.

Nori Henson called the licensee Ethel Henson who stated she was on her way to the facility to meet with the LPA. The licensee did not come to the facility however sent her son, Wymon Henson a.k.a. Monty to meet with the LPA. Mr. Henson provided a tour of the entire preschool.

During the inspection, LPA reviewed fingerprint clearances for the staff and observed Staff #1 does not have a criminal record clearance. The licensee was informed on 10/13/22 that all adults working on the premises are required to have a Criminal Record Clearance.

In addition, during the inspection LPA observed a child go to the restroom unsupervised inside of the main building of the office. LPA learned that the child walked alone from a classroom.

Both of these deficiencies are violations according to Title 22 Regulations.

See LIC 809D

Exit interview. A copy of this report will be provided via email due to technical difficulties.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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 12/09/2022 01:03 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 12/08/2022 at 05:38 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: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/09/2022
Section Cited
CCR
101170(e)

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101170-Criminal Record Clearance-All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility.
Evidence by: LPA observed Nori Henson on the premises greeting parents.
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Licensee will ensure that all employees working on the premises are fingerprint cleared prior to working or being on the premises. The licensee will submit a plan of correction to the Department by 12/9/22. The staff member #1 will not be allowed on the premises until fingerprint clearance is received.
Type A
12/09/2022
Section Cited
CCR
101229(a)(1)

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101229(a)(1) -Responsibility for Providing Care and Supervision-The licensee shall provide care and supervision as necessary to meet the children's needs.No child(ren) shall be left without the supervision of a teacher at any time. Supervision shall include visual observation.
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Licensee will ensure that all children are supervised at all times. Licensee will submit a Plan of Correction to the Department by 12/9/22. The licensee will have a meeting with all the staff and submit the meeting agenda to the Department as well as the roster of all teachers that attended the meeting.
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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:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/08/2022


LIC809 (FAS) - (06/04)
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