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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870510
Report Date: 01/31/2023
Date Signed: 01/31/2023 04:16:21 PM

Document Has Been Signed on 01/31/2023 04:16 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ALEXANDRIA EARLY EDUCATION CENTERFACILITY NUMBER:
191870510
ADMINISTRATOR:IMELDA MENDEZFACILITY TYPE:
850
ADDRESS:4304 ROSEWOOD AVENUETELEPHONE:
(323) 662-8127
CITY:LOS ANGELESSTATE: CAZIP CODE:
90004
CAPACITY: 115TOTAL ENROLLED CHILDREN: 71CENSUS: 54DATE:
01/31/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Office Manager, Dennis Colon &
Principal, Imelda Mendez 		TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Case Management inspection due to an incident that was reported to the Department on December 5, 2022. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Office Manager, Dennis Colon who guided LPA on a tour of the facility. Principal Imelda Mendez was present however, unavailable for the tour. Census was taken.

On December 5, 2022 an unusual incident report was made to the department regarding an incident that involved a child who sustained injury on December 1, 2022 that required medical attention. The facility did not reported this incident to the Department within the required 24 hours.



Based on information obtained during interviews conducted with staff and the parent of child in question, LPA Garcia determined that during outdoor play child bumped into another child and fell and hit the lower chin area on the concrete floor. Although staff was present and observed the incident, staff could not reach the child in time to prevent fall. At 9:13 a.m., during this inspection LPA did not observe any tripping hazards on the area where incident took place. Child was taken to the doctor and received glue on the wound. Child has returned to day care.
REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ALEXANDRIA EARLY EDUCATION CENTER
FACILITY NUMBER: 191870510
VISIT DATE: 01/31/2023
NARRATIVE
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Based on information obtained during this investigation regarding the incident reported, the facility failed to follow all proper procedures. Although facility Staff administered first aid, child’s parent was notified, and all medical needs were met. However, the incident took place on December 1, 2022 and the report was submitted to the Department on December 5, 2022 therefore, the report was not sent in properly and timely. Per Principal, staff reminded children to walk and not run to prevent falls in the future. In addition, Principal will provide all staff with training to review protocols and reporting requirements.

The following deficiency is being cited in accordance to Title 22 of the California Code of Regulations. Please refer to LIC809D for documentation of deficiency cited.



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


Exit interview conducted and report was reviewed with the facility representative, Imelda Mendez.


END OF REPORT: PAGE 2 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/31/2023 04:16 PM - It Cannot Be Edited


Created By: Mireya Garcia On 01/31/2023 at 01:04 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ALEXANDRIA EARLY EDUCATION CENTER
FACILITY NUMBER: 191870510

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/10/2023
Section Cited
CCR
101212(d)(1)(B)

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(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:(B) Any injury to any child that requires medical treatment. This requirement is not met as evidenced by:
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Per Principal, staff reminded children to walk and not run to prevent falls in the future. In addition, Principal will provide all staff with training to review protocols and reporting requirements. Principal will then submit Training material; agenda and staff sign in sheet to LPA Garcia via email by POC due date 2/10/23.
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Based on information obtained during this investigation regarding the incident reported, it was disclosed the incident took place on December 1, 2022 and the report was submitted to the Department on December 5, 2022 therefore, the report was not sent in properly and timely. This poses a potential health and safety risk to children 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023


LIC809 (FAS) - (06/04)
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