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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191670971
Report Date: 09/09/2024
Date Signed: 09/09/2024 11:13:47 AM

Document Has Been Signed on 09/09/2024 11:13 AM - 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:ST JOHNS CHILD STUDY CENTERFACILITY NUMBER:
191670971
ADMINISTRATOR/
DIRECTOR:		LAURA OSORIOFACILITY TYPE:
850
ADDRESS:1339 20TH STREETTELEPHONE:
(310) 829-8921
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 21DATE:
09/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Laura Benavente, DirectorTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 09/09/2024, Licensing Program Analyst (LPA) Judy Laureano, conducted a case management inspection to follow up on an Unusual Incident reported to the department on 07/26/2024. LPA Laureano met with Laura Benavente who guided LPA on facility tour.

Program operates an infant program on same location and LPA toured both programs.
LPA toured the facility indoor and outdoors and observed the following:
Classroom B- 5 children and 2 staff member
Classroom C- 11 children and 2 staff members
Therapeutic Classroom E and F- 4 children and 3 staff members and 1 OT

Infant program classrooms were observed with 14 children and 7 staff members.

The El Segundo Child Care Regional Office (ESRO) received information from director regarding a self reporting incident that occurred at the preschool program on 7/25/2024. Facility emailed LPA Laureano the Unusual Incident Report stating that around 3:00 p.m. in classroom C, children were waking up from nap time and Staff 1 approached Child 1, when S1 was close to child, child extended the hand to show S1 the content C1 was holding. S1 observed two yellow and brown pills. S1 asked C1 if anything was swallowed and C1 stated no. S1 proceeded to check the area of the cot and blankets and found one additional pill. S1 contacted supervisor on site and informed supervisor of the incident.

The classroom was checked and it was determined that Substitute teacher was the individual helping C1 during nap time. Supervisor contacted Director who spoke to substitute teacher. Substitute teacher confirmed the pills found were multivitamins and that they belonged to her. Director contacted child’s family and child is still enrolled in program.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: ST JOHNS CHILD STUDY CENTER
FACILITY NUMBER: 191670971
VISIT DATE: 09/09/2024
NARRATIVE
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Based on document review and interviews, LPA cited 1 Type A deficiency during today’s visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1. Please see LIC 809D.

Effective January 1, 2009, all licensees must comply with Assembly Bill (AB) 978. Assembly Bill 978 requires the assessment of an immediate civil penalty for designated serious violations at community care facilities.

Effective January 1, 2007, the licensee must comply with Assembly Bill 633 as follows: Copies of any licensing report that documents a Type A citation - this includes facility visits and substantiated complaint investigations. Copies of any licensing documents pertaining to a noncompliance conference between licensing management and licensees. Copies of a summary of an accusation indicating the Department’s intent to revoke the facility’s licenses. Copies of any of the above licensing documents the licensee has
received in the prior 12 months shall be provided to parents/guardians of newly enrolling children. The licensee shall keep verification of receipt in each child’s file at the facility as proof of compliance (LIC 9224).

Upon on receipt of this report, the Licensee shall post the Notice of Site Visit. The Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

An exit interview was conducted, and report was reviewed with Director Laura Benavente. Copy of this report and appeal rights were discussed and left with director whose signature on this form confirm receipt of these documents.
Based on the information obtained, interviewed conducted, Facility will be cited for one Type A citation, please see LIC 809D for reference.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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Document Has Been Signed on 09/09/2024 11:13 AM - It Cannot Be Edited


Created By: Judy Laureano On 09/09/2024 at 10:40 AM
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: ST JOHNS CHILD STUDY CENTER
FACILITY NUMBER: 191670971

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/09/2024
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights:
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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Director dicussed Facility's Procedures for All Teachers & Assistants on 8/12/2024. All procedures are given to all new hires. Procedures have been modified to higlight the importance of storing personal belognings .
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This requirement is not met as evidence by, per LPA Laureano's document review and interviews, child 1 had access to multivitamins that were found in the classroom, which poses an immediate health and safety risks to persons in care.
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Facility provided LPA with copies of procedures.

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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Judy Laureano
LICENSING EVALUATOR SIGNATURE:
DATE: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


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