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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870884
Report Date: 07/03/2024
Date Signed: 07/03/2024 05:10:31 PM

Document Has Been Signed on 07/03/2024 05:10 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:SHENANDOAH EARLY EDUCATION CENTERFACILITY NUMBER:
191870884
ADMINISTRATOR/
DIRECTOR:		COLLINS, CAROLFACILITY TYPE:
850
ADDRESS:8861 BEVERLYWOOD ST.TELEPHONE:
(310) 838-7328
CITY:LOS ANGELESSTATE: CAZIP CODE:
90034
CAPACITY: 115TOTAL ENROLLED CHILDREN: 115CENSUS: DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Marcello Lopez, Principal TIME VISIT/
INSPECTION COMPLETED:
05:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incidences that occurred at the facility. LPA arrived at the facility at 9:35AM and met with Marcello Lopez, Principal, who guided LPA on a tour of the facility. There were 42 children and 16 staff present upon arrival.

The incident that occurred on 05/16/2024, was reported to the Department on 05/16/2024, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.
Information reported to the Department indicated that staff# 2 may or may not have violated the personal rights of Child #1.
LPA conducted interviews regarding this incident. LPA also obtained rosters and other pertinent information. During the interviews, LPA was not able to obtain enough information to determine if Child #1 personal rights were violated.

The incident that occurred on 05/31/2024, was reported to the Department on 06/03/2024, via email. The facility did not report the Unusual Incident to the Department within the required 24 hours of occurrence.
Information reported to the Department indicated that Child #2 injured Child #3 when Child #2 throw a bin towards the table Child #3 was sitting at.
LPA conducted interviews regarding this incident. During the interviews, LPA was provided with a video recording that was taken by Staff #3 that captured the incident.

Based upon information received from the interviews and video recording, it was determined that staff did not provide care and supervision as necessary to meet the children's needs and did not prevent injury to Child #2. This was an immediate risk to the health and safety of children in care. The following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety. ---Page 1 of 3
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SHENANDOAH EARLY EDUCATION CENTER
FACILITY NUMBER: 191870884
VISIT DATE: 07/03/2024
NARRATIVE
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The incident that occurred on 06/07/2024, was reported to the Department on 06/10/2024, via email. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.
Information reported to the Department indicated that Staff #4 may or may not have violated the personal rights of Child #4.
LPA conducted interviews regarding this incident. LPA also obtained rosters and other pertinent information. During the interviews, LPA was not able to obtain enough information to determine if Child #4 personal rights were violated.

The incident that occurred on 07/02/2024, was reported to the Department on 07/03/2024, via email. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.
Information reported to the Department indicated that Staff #5 may or may not have violated the personal rights of Child #5.
LPA conducted interviews regarding this incident. LPA also obtained rosters and other pertinent information. LPA interviewed Child #5, Staff #6 and Staff #7 who were present when the alleged incident occurred. No disclosures were made to support the incident that was reported to the facility.

Based upon the information received during the interviews, it was determined that the personal tights of Child #5 were not violated. There were no deficiencies cited for the incident that reported to the Department on 07/03/2024.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. A copy of the LIC 9224 Acknowledgement of Receipt of Licensing Reports was provided during this visit.

The Notice of Site Visit was given and must remain posted for 30 days during the hours of operation after each site visit by a licensing representative.

Exit interview was conducted and report was reviewed with Marcello Lopez, Principal. ---Page 2 of 2
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 07/03/2024 05:10 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 07/03/2024 at 04:40 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: SHENANDOAH EARLY EDUCATION CENTER
FACILITY NUMBER: 191870884

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/09/2024
Section Cited
CCR
101229(a)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
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Per Principal, Training's and strategies previously provided to staff will be re-evaluated to determine what additional training is needed to prevent future occurrences. An agenda of training's that will be provided to staff will be submitted to LPA via email by 07/17/2024. Once training's occurred, staff sign in sheets will be submitted to LPA by 08/09/2024.
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This requirement was not met as evidenced by interviews conducted, disclosures made and video recording provided, it was determined that staff did not provide care and supervision as necessary to meet the children's needs and did not prevent injury to Child #2. This was an immediate risk to the health and safety of children in care.
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Type A
08/09/2024
Section Cited
CCR101216(a)

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Personnel Requirements (a) Child care center personnel shall be competent to provide the services necessary to meet the individual needs of children in care...
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Per Principal, Training's and strategies previously provided to staff will be re-evaluated to determine what additional training is needed to prevent future occurrences. An agenda of training's that will be provided to staff will be submitted to LPA via email by 07/17/2024. Once training's occurred, staff sign in sheets will be submitted to LPA by 08/09/2024.
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This requirement was not met as evidenced by interviews conducted, disclosures made and video recording provided, that staff was not able to provided services to meet the individual needs of Child #3. This was an immediate risk to the health and safety of 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 07/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2024


LIC809 (FAS) - (06/04)
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