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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416694
Report Date: 01/22/2024
Date Signed: 01/22/2024 02:10:47 PM

Document Has Been Signed on 01/22/2024 02:10 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:WASHINGTON PRIMARY CENTERFACILITY NUMBER:
197416694
ADMINISTRATOR:ALLISON SPEIGHTFACILITY TYPE:
850
ADDRESS:860 W. 112TH STREET RM K1 & K2TELEPHONE:
(323) 779-7550
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 8DATE:
01/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mary Seay, Principal TIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incident that occurred on 12/05/2023. LPA arrived at the facility at 9:30AM and met with Mary Seay, Principal, who guided LPA on a tour of the facility. There were 8 children and 3 staff present upon arrival.

The purpose of the visit was to follow-up on an incident that was reported to the department.

On 12/12/2023, LPA Hernandez conducted interviews, obtained records, and other pertinent information.

Information reported to the Department indicated that Staff #3 may or may not have violated the personal rights of Child# 1.

While interviewing staff, Staff #1 and Staff #2 observed Child #1 feet dragging from one location of the room to another as Staff #3 held Child#1 by the arm. Staff # 3 stated that they indeed held Child #1 by the arm, above the elbow. Staff #3 stated that Child #1 did not want to walk and Staff #3 continued to pull Child#1 in order to bring Child #1 closer to Staff #3 to take a photo.

Based on interviews, record review(s), and statements of admission provided by Staff #3, it was determined that the personal rights of child #1 were violated when Child #1 was being pulled by Staff #3. This was an immediate risk to the health and safety of children in care.

California Code of Regulations, Title 22, Division 12, Chapter 1, 101223(a)(3) Personal Rights is being cited on the attached LIC9099D.

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SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694
VISIT DATE: 01/22/2024
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 Mary Seay, Principal.

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

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/22/2024 02:10 PM - It Cannot Be Edited


Created By: Lilia Hernandez On 01/22/2024 at 11:59 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
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WASHINGTON PRIMARY CENTER
FACILITY NUMBER: 197416694

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/24/2024
Section Cited
CCR
101223(a)(3)

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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...
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Per Principal, a staff meeting was held and personal rights were reviewed and discussed on 12/11/2023. A copy of the agenda and sign in sheet will be submitted to LPA via email by the POC due date.
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This requirement was not met as evidenced by interviews conducted and disclosures made indicating that Staff # 3 stated that they indeed held Child #1 by the arm, above the elbow. Staff #3 stated that Child #1 did not want to walk and Staff #3 continued to pull Child#1 in order to bring Child #1 closer to Staff #3 to take a photo.
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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: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/22/2024


LIC809 (FAS) - (06/04)
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