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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416596
Report Date: 05/07/2024
Date Signed: 05/07/2024 01:24:17 PM

Document Has Been Signed on 05/07/2024 01:24 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:MAGNOLIA ELEMENTARY SCHOOL CSPPFACILITY NUMBER:
197416596
ADMINISTRATOR/
DIRECTOR:		VELASCO, LUISFACILITY TYPE:
850
ADDRESS:1626 ORCHARD AVENUETELEPHONE:
(213) 748-6281
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY: 72TOTAL ENROLLED CHILDREN: 32CENSUS: 30DATE:
05/07/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Teacher Yesenia Victoria TIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Roxana Lopez conducted a Case Management Deficiencies visit on this date to address deficiencies revealed during a Case Management Lead Inspection. Census was taken.

LPA arrived at the facility at 11:40 am and walked to room # 31, met with Teacher Yesenia Victoria. Teacher informed LPA that both classrooms 31 & 32 are preschool classes and children were having lunch. LPA did not observed any children in the classroom- Per teacher both classes were having lunch with the teacher aides and the teachers were on their lunch brake. LPA was walked to the lunch tables where she observed 2 teacher aides out of ratio with 30 children and no qualified teacher present. This is an immediate risk for the health and safety of children. LPA advised teachers that children have to be directly supervised by a fully qualify teacher. Teacher's informed LPA that this is the way that lunch and breaks are covered.

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety

LPA Roxana Lopez informed Facility Representative Erika Moreno that this report dated 5/7/2024 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Roxana Lopez informed the Licensee to provide a copy of this licensing report dated 5/7/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day --- pg. 1 of 2
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/07/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: MAGNOLIA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416596
VISIT DATE: 05/07/2024
NARRATIVE
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or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report.

A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Facility Representative Erica Moreno.

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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2024 01:24 PM - It Cannot Be Edited


Created By: Roxana Lopez On 05/07/2024 at 12:26 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: MAGNOLIA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
101216.2(e)

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101216.2 Teacher Aide Qualifications and Duties: (e)An aide shall work only under the direct supervision of a teacher. This requirement is not met as evidenced by:
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Per Vice Principal they will contact the ECC Director to work on a compliance plan and submit plan to LPA via emai by 05/31/2024.
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Based on observation the licensee did not comply with the section cited above in that 2 Teacher aides were observed in the lunch area with 30 children and no qualify teacher. Which poses/posed a potential health, safety or personal rights risk to persons 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/07/2024 01:24 PM - It Cannot Be Edited


Created By: Roxana Lopez On 05/07/2024 at 12:29 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: MAGNOLIA ELEMENTARY SCHOOL CSPP
FACILITY NUMBER: 197416596

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/07/2024
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidence by:
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Per Vice Principal they will Principal will contact the ECC Director to work on a plan to keep facility in ratio at all times. Plan will be submited via email by 5/31/2024.
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Based on observation the licensee did not comply with the section cited above in that 2 Teacher aides were observed to be out of ratio in the lunch area with 30 children. Which poses/posed an immediate health, safety or personal rights risk to persons 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 05/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/07/2024


LIC809 (FAS) - (06/04)
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