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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890351
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:48:42 PM

Document Has Been Signed on 10/20/2022 02:48 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:GATES STREET EARLY EDUCATION CENTERFACILITY NUMBER:
191890351
ADMINISTRATOR:SCARLETT RAMIREZ-HOLGUINFACILITY TYPE:
850
ADDRESS:2306 THOMAS STREETTELEPHONE:
(323) 222-0277
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 114TOTAL ENROLLED CHILDREN: 55CENSUS: 51DATE:
10/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Scarlett Ramirez-HolguinTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced Case Management inspection due to an incident that was reported to the Department on September 30, 2022. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Principal, Scarlett Ramirez-Holguin who guided LPA on a tour of the facility. Census was taken.

On September 30, 2022 an unusual incident report was made to the department regarding an incident that involved a child who sustained injury that did not require medical attention. The facility reported this incident to the Department within the required 24 hours. Based on information obtained during interviews conducted with staff, witness and the parent of child in question, LPA Garcia determined that during outdoor play child was running and ran into a music instrument (Autoharp) that was being held by Staff #1 and hit their forehead. Although staff was present and observed the incident, staff could not reach the child in time to prevent child from running into the instrument. During this inspection LPA Garcia took pictures of the Autoharp and did not observe any tripping hazards near or on the area where incident took place. 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: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2022
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
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: GATES STREET EARLY EDUCATION CENTER
FACILITY NUMBER: 191890351
VISIT DATE: 10/20/2022
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Based on information obtained during this investigation, no follow up is necessary regarding the incident reported. The facility followed all proper procedures; Staff administered first aid, child’s parent was notified, incident report was sent in properly and timely and first aid was administered to child. Per Principal, staff reminded children to walk and not run to prevent falls, injuries in the future. In addition, musical instrument has been removed.

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

Exit interview conducted and report was reviewed with facility representative, Scarlett Ramirez-Holguin.


END OF REPORT: PAGE 2 OF 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC809 (FAS) - (06/04)
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