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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871007
Report Date: 04/20/2022
Date Signed: 04/20/2022 02:07:47 PM

Document Has Been Signed on 04/20/2022 02:07 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CHILDREN'S COLLECTIVE, INC. THEFACILITY NUMBER:
191871007
ADMINISTRATOR:CHENIEKA MORGAN-MILLFACILITY TYPE:
850
ADDRESS:3817 S. SAN PEDRO ST.TELEPHONE:
(323) 231-1367
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 24DATE:
04/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Tameka Devine, Site SupervisorTIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analysts Mayra Rivera conducted an unannounced Case Management Inspection after a previous 2/8/22 inspection. LPA met with Site Supervisor Tameka Devine who guided the LPA on a tour of the facility.

Based on the information provided by staff and site supervisor, in the month of December 2021, there were confirmed Covid 19 positive cases reported to Site Supervisor. Site Supervisor did not report the confirmed Covid 19 positive cases to Community Care Licensing or to the Department of Public Health Los Angeles.
Based on the available information it does appear this incident is a result of a Title 22 violation for not reporting epidemic outbreaks. The facility has been cited and given a deficiency.

The content of this report was read and discussed and n exit interview was conducted with Site Supervisor Tameka Devine; the notice of site visit must be posted for 30 days upon receipt and appeal rights were given and explained.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Mayra Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2022
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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Document Has Been Signed on 04/20/2022 02:07 PM - It Cannot Be Edited


Created By: Mayra Rivera On 04/20/2022 at 01:32 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDREN'S COLLECTIVE, INC. THE
FACILITY NUMBER: 191871007

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2022
Section Cited
CCR
101212(d)(1)(E)

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Reporting Requirements
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....
Epidemic outbreaks.
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Per Site Supervisor, she reviewed the code of Regulation 101212 and the current health orders by the Department of Public Health Los Angeles. Site Supervisor will enrolled to the Local Licensing Call dated 2/22/22 and 2/23/22 at 2pm.
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This regulation was not met by: Based on the interviews and Site Supervisor statement not reporting Covid Positives to Community Care Licensing or Department of Public Health. This poses a potential health, safety, or personal rights 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:Karen Chambers
LICENSING EVALUATOR NAME:Mayra Rivera
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022


LIC809 (FAS) - (06/04)
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