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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191890404
Report Date: 04/04/2022
Date Signed: 04/04/2022 10:20:34 AM

Document Has Been Signed on 04/04/2022 10:20 AM - 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:PLACITA DE NINOSFACILITY NUMBER:
191890404
ADMINISTRATOR:ALICIA LOMELIFACILITY TYPE:
850
ADDRESS:2661 PASADENA AVETELEPHONE:
(323) 223-2420
CITY:LOS ANGELESSTATE: CAZIP CODE:
90031
CAPACITY: 54TOTAL ENROLLED CHILDREN: 55CENSUS: 29DATE:
04/04/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Vicky Rodriguez TIME COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted an unannounced Case Management inspection on this day. LPA met with Vicky Rodriguez, Lead Tacher. LPA guided self on facility tour due to there not being any available staff to guide LPA on tour.

The purpose of this visit was to ensure that the Licensee is in compliance with Title 22 regulations.

During this inspection, at approximately 8:57 AM LPA observed the Lead Teacher walk child (C1) to the door from outside to enter the building to use the restroom. Child was handed off to an aide, the child then walked to the restroom by themselves. The child was observed in the restroom alone with no supervision of any staff for approximately 3 minutes. At 9:00 AM LPA observed another child, C2 alone in the other restroom with no supervision of any staff. There were 2 teacher assistants in the classroom, as well as the housekeeper, however, the 2 children were observed alone in the restroom.

This was an immediate risk to the health and safety of children in care. Please see LIC 809D for deficiency cited.

Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided.

Exit interview was conducted with Site Supervisor, Mirna Palomo. Appeal rights and procedures were explained and provided.
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2022
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 04/04/2022 10:20 AM - It Cannot Be Edited


Created By: Judy Mora On 04/04/2022 at 09:31 AM
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: PLACITA DE NINOS
FACILITY NUMBER: 191890404

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/05/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision
No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
This requirement was not met as evidenced by
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Site Supervisor states a meeting will be held with all staff in regards to supervision. Site Supervisor states minutes of meeting will be provided to LPA. Minutes will be submitted to LPA by POC due date of 04/05/22.
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LPA observation on 04/04/22. LPA observed 2 children in the restroom alone with no staff supervision. 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Judy Mora
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022


LIC809 (FAS) - (06/04)
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