<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806026
Report Date: 05/03/2023
Date Signed: 05/03/2023 04:04:15 PM

Document Has Been Signed on 05/03/2023 04:04 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GREGORY PARK HEAD START/STATE PRE SCHOOLFACILITY NUMBER:
191806026
ADMINISTRATOR:MARCIE HOUCHENFACILITY TYPE:
850
ADDRESS:5807 GREGORY AVE.TELEPHONE:
(323) 463-3061
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 44DATE:
05/03/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Samira Alvarez, Child Development SupervisorTIME COMPLETED:
04:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Mireya García conducted a Case Management Deficiencies Inspection to address deficiency discovered during LPA's visit conducted on March 23, 2023. LPA Garcia met with Child Development Supervisor (CDS) Samira Alvarez who provided a tour of the facility both indoors and outdoors. Census was taken.

On March 23, 2023, during interviews conducted with Staff #1 disclosures were made that on March 13, 2023 during outside play time child #1 open the facility gate and ran out of the facility. Staff #1 observed when child grab the gate handle and open it. Staff #1 ran after child and was able to grab child outside of the gate. Staff #1 disclosed child was outside gate alone on the sidewalk by the entrance gate for less than 4 seconds. Staff #1 states, child was able to open door since self-closing latch was not working properly. Interview conducted with Staff #4 and CDS confirm incident took place at the facility. The facility did not report this incident as required to the Department. The facility is therefore being cited for failure to report this incident to the Department within the required 24 hours.

The deficiency listed on the following page is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809d.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Samira Alvarez.


REPORT ENDS HERE PAGE 1 OF 1.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 05/03/2023 04:04 PM - It Cannot Be Edited


Created By: Mireya Garcia On 05/03/2023 at 02:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GREGORY PARK HEAD START/STATE PRE SCHOOL
FACILITY NUMBER: 191806026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited
CCR
101212(a)(d)(1)(C)

1
2
3
4
5
6
7
101212 Reporting Requirements: (a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Per CDS Samira facility will submit written report to the Department and will conduct training with staff to review reporting requirements. CDS she will submit training material; staff sign in sheet and agenda to LPA Garcia via email by POC due date 03/10/2023.
8
9
10
11
12
13
14
LPA Garcia’s records review and staff disclosures facility failed to report incident that occurred on 03/13/2023 to the Department within the required 24 hours. This poses a potential health and safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 05/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/03/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2