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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414037
Report Date: 04/25/2024
Date Signed: 04/25/2024 02:57:07 PM

Document Has Been Signed on 04/25/2024 02:57 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CCRC HEAD START - RESEDAFACILITY NUMBER:
197414037
ADMINISTRATOR/
DIRECTOR:		ARACELI GROSSMANFACILITY TYPE:
850
ADDRESS:18120 SATICOY STREETTELEPHONE:
(818) 705-0113
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 39DATE:
04/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Elizabeth FloresTIME VISIT/
INSPECTION COMPLETED:
03:05 PM
NARRATIVE
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 On 04//25/2024 at 10:20 a. m Licensing Program Analyst (LPA) Doris Whitmore conducted a Case Management Incident inspection visit for the purpose of following up on an Unusual Incident Report (UIR). The incident occurred on 01/11/24.LPA Whitmore met with Elizabeth Flores, Center Director, and discussed the purpose of the visit. LPA observed 37 children in care and 10 staff.

According to the UIR, at 2:40 p.m. a parent came to pick up her child as she left the classroom (C1 followed her out. Before exiting the courtyard, the parent noticed (C1) was following her. Within a minute, the parent went to the office with the (C1) and informed the Center Director that (C1) was outside by herself.

LPA obtained a copy of( C1), Sign in and out sheet and Policy on Care and Supervision, & handouts on Care and Supervision .LPA reviewed ( C1) file and documentation on staff trainings that were provided after incident.



Based on the available evidence information obtained throughout the course of the investigation, which included interviews with facility staff and child there was a lack of care and supervision due to child leaving out the classroom and following a parent. Staff did not see the child leaving out the classroom. Child did not leave the premises and was brought back by the parent.

LPA Whitmore conducted exit interview with Elizabeth Flores and explained that the deficiency was a Type A. Please see LIC809D.Licensing Program Analyst (LPA) provided LIC9224 and instructed to provide copies of this report to all parents of children currently enrolled. Also, to obtain the parent's signature on form LIC9224, as acknowledgment that they received a copy of this report and any new enrolled children. Form LIC9224 is to be retained in the child's file.
Copy of report and Notice of Site Visit was issued.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024
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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CCRC HEAD START - RESEDA
FACILITY NUMBER: 197414037
VISIT DATE: 04/25/2024
NARRATIVE
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On 04/25/2024, Licensing Program Analyst (LPA) Doris Whitmore conducted an interview with Staff #1 for the purpose of conducting an unannounced Case Management Incident.
LPA: What is your Name?
S1:
LPA: What is your Position?
S1:
LPA: What are your hours?
S1:
LPA: What classroom do you work in?
S1:
LPA: What are the names of the other teachers who work in the classroom with you?
S1:
LPA: Can you briefly describe what happened when the child left the classroom and followed a parent?
S1:
LPA: How many staff were present when this happened?
S1:
LPA: How many children were in care that day?
S1:
LPA: Where were you positioned when the incident occurred?
S1:
LPA: What did you observe when the incident occurred?
S1:
LPA: What is the policy and procedure on Care & Supervision?
S1:
LPA: Can you tell me if you conduct headcounts?
S1:
LPA: What activity are the children engaged in at 2:40p.m.
S1:
LPA: Can you tell me if you conduct head counts when children leave to go home?
S1:
LPA: Did you see when the child left the classroom?
S1:
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/25/2024 02:57 PM - It Cannot Be Edited


Created By: Doris Whitmore On 04/25/2024 at 02:33 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: CCRC HEAD START - RESEDA
FACILITY NUMBER: 197414037

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/01/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time.
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To repeat and to review the six active strategies on Care and Supervision with all staff and to provide a sign in sheet of training.
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except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not bet due to lack of supervision.
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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:Karren Starks
LICENSING EVALUATOR NAME:Doris Whitmore
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2024


LIC809 (FAS) - (06/04)
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