197402294-10-27-2021-33-CC-MGAA-C87UVJ-20211027155514

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197402294
Report Date: 10/27/2021
Date Signed: 10/27/2021 03:55:23 PM

Document Has Been Signed on 10/27/2021 03:55 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:	FIRST STREET ELEMENTARY SCHOOL ROOM 24		FACILITY NUMBER:	197402294
ADMINISTRATOR:	CRESS, HOBART F.		FACILITY TYPE:	850
ADDRESS:	2820 EAST FIRST STREET		TELEPHONE:	(323) 269-0138
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90033
CAPACITY: 23	TOTAL ENROLLED CHILDREN: 18	CENSUS: 8	DATE:	10/27/2021
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Luis Cuevas, Principal		TIME COMPLETED:	03:55 PM

NARRATIVE

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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced case management inspection due to an incident that occurred on 10/13/2021. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Luis Cuevas, Principal, who guided LPA on a tour of the facility. Upon arrival, the following staff were present: Staff #1, #2 and #3 with eight (8) preschoolers.

The incident that occurred on 10/13/2021 was reported to the Department on 10/14/2021, 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 violated Child #1's personal rights.

During interviews conducted with staff, disclosures were made regarding a Personal Rights violation conducted by Staff #1. More than one (1) Staff confirmed this information.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

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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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: FIRST STREET ELEMENTARY SCHOOL ROOM 24	FACILITY NUMBER: 197402294
	VISIT DATE: 10/27/2021

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Based upon information received from the interviews conducted it was determined that the personal rights of Child #1 were violated by Staff #1. This poses a potential health and safety risk to children in care. Title 22 Regulation Section 101223 Personal Rights states (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 or other actions of a punitive nature including but not limited to interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

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). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Principal was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form (English/Spanish).

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

Exit interview conducted and report was reviewed with facility representative, Luis Cuevas.

END OF REPORT: PAGE 2 OF 2

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/27/2021 03:55 PM - It Cannot Be Edited

Created By: Mireya Garcia On 10/27/2021 at 01:10 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: FIRST STREET ELEMENTARY SCHOOL ROOM 24	FACILITY NUMBER: 197402294
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/28/2021 Section Cited CCR 101223(a)(3)	1 2 3 4 5 6 7	Personal Rights: (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 or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Per Principal, he will conduct training for all staff regarding children’s personal rights in child care in addition, review of CCL Children’s Personal Rights in Child Care video https://ccld.childcarevideos.org/child-care-center-operators/childrens-personal-rights-in-child-care/
	8 9 10 11 12 13 14	LPAs interviews conducted with staff reveal, disclosures were made regarding a Personal Rights violation conducted by Staff #1. More than one (1) Staff confirmed this information. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14	Staff will provide a video written response and compliance plan. Principal will send LPA Garcia via email training staff agenda, sign in sheet and staff written responses/compliance plan by POC due date 10/28/2021.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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:

Brandi VanOosten

LICENSING EVALUATOR NAME:

Mireya Garcia

LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2021

LIC809 (FAS) - (06/04)

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