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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870376
Report Date: 10/27/2022
Date Signed: 10/27/2022 05:25:02 PM

Document Has Been Signed on 10/27/2022 05:25 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:COMMUNITY CHILD DEV. CTR. OF LITTLE ANGELSFACILITY NUMBER:
191870376
ADMINISTRATOR:MASSENGALE, ANGELAFACILITY TYPE:
850
ADDRESS:3808 WEST 54TH ST.TELEPHONE:
(323) 299-0189
CITY:LOS ANGELESSTATE: CAZIP CODE:
90043
CAPACITY: 129TOTAL ENROLLED CHILDREN: 129CENSUS: 45DATE:
10/27/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:54 PM
MET WITH:Angela MassengaleTIME COMPLETED:
05:39 PM
NARRATIVE
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On 10/27/2022 Licensing Program Analyst (LPA) Laticia Thompson conducted an unannounced complaint investigation and observed the following Deficiencies at the facility above:

LPA observed Staff member #1 caring for children without a criminal background exemption clearance.
The facility was unable to provide a roster of children currently enrolled in the facility
The facility was unable to provide complete staff and children files/records.

Please see Facility Evaluation Report (809D)

The facility has been issued a Technical Violation for incomplete children and staff Files

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Laticia S Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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 10/27/2022 05:25 PM - It Cannot Be Edited


Created By: Laticia S Thompson On 10/27/2022 at 04:04 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: COMMUNITY CHILD DEV. CTR. OF LITTLE ANGELS
FACILITY NUMBER: 191870376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2022
Section Cited
CCR
101170(e)(3)

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101170 Criminal Record Clearancee) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working..in a licensed facility(3)Request and be approved for a transfer of a criminal record exemption... be present at the facility. This requrement was not met
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Staff member will not return to facility until the criminal background clearanc has been processed. Licensee will continue to process clearance through Guardian. Licensee will contact the deparement when staff member has been associated with the facility.
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Based on review of records LPA Thompson determined the facility did not confirm the request for a transfer of a criminal record exemption completed and approved, which poses an immediate Health & Safety risk to children in care
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Type B
10/27/2022
Section Cited
HSC1596.841

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1596.841 Current roster of children provided care in facility required Each child day care facility...the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and This roster shall be available to the licensing agency upon request. This requirement is not met by evidence by
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The Director agrees to provide a current roster to the department by Close of Business 11/1/2022
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Based on record review the facility was unable to provide a roster of children currently enrolled in the facility This poses a potential Health and Safety Risk to chidlren in care.
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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:Lisa Rios
LICENSING EVALUATOR NAME:Laticia S Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022


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