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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402054
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:30:04 PM

Document Has Been Signed on 11/07/2024 04:30 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:LASSEN ELEMENTARY SCHOOL PRESCHOOLFACILITY NUMBER:
197402054
ADMINISTRATOR/
DIRECTOR:		MOORE, LANCEFACILITY TYPE:
850
ADDRESS:15017 SUPERIOR STREET K-3,K-4TELEPHONE:
(818) 892-8618
CITY:SUPELVEDASTATE: CAZIP CODE:
91343
CAPACITY: 46TOTAL ENROLLED CHILDREN: 46CENSUS: 27DATE:
11/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:01 PM
MET WITH:Uchenna Okereke, PrincipalTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to a self-reported incident that occurred at the facility. LPA arrived at the facility at 2:01PM and met with Uchenna Okereke, Principal, who guided LPA on a tour of the facility. There were 27 children in care and 5 staff present upon arrival.

The incident that occurred on 08/22/2024, was reported to the Department on 08/23/2024, 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 #1 was observed violating the personal rights Child #1.

LPA conducted interview with Principal, interviews with Staff #1 – Staff #5 and obtained written statements for this incident.

Principal disclosed that the incident reported required Child #1 to be removed from their classroom and placed in a different classroom. During staff interviews, Staff #4 submitted a written statement as a witness to Staff #1 pulling Child #1 from their arm. Staff #1 forced Child #1 to use the restroom after Child #1 stated to Staff #1 that they did not need to use the restroom.

Based upon information received from the interviews conducted it was determined that Staff #1 violated the personal rights of Child#1. This is an immediate risk to the health and safety of children in care.

The following deficiency listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.
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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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: LASSEN ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 197402054
VISIT DATE: 11/07/2024
NARRATIVE
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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 Uchenna Okereke, Principal.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/07/2024 04:30 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 11/07/2024 at 03:43 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: LASSEN ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 197402054

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2024
Section Cited
CCR
101223(a)(3)

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(a)The licensee shall ensure that each child is accorded the following personal rights...(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse...

This requirement was not met as evidenced by:
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Per Principal, personal rights for children will be reviewed with staff and a signed staff acknowledgment will be submitted via email to LPA by 11/05/2024.
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Based on interviews conducted and written statements obtained indicating that Staff #4 witnessed Staff #1 pulling Child #1 from their arm, forced Child #1 to use the restroom after Child #1 stated to Staff #1 that they did not need to use the restroom which poses an immediate health, safety, and 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:Rita Ramos
LICENSING EVALUATOR NAME:Lilia Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2024


LIC809 (FAS) - (06/04)
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