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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197420046
Report Date: 10/14/2021
Date Signed: 10/18/2021 08:59:57 AM

Document Has Been Signed on 10/18/2021 08:59 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VAN NUYS PRESCHOOLFACILITY NUMBER:
197420046
ADMINISTRATOR:MOON, YOUNGSUNFACILITY TYPE:
850
ADDRESS:6260 TYRONE AVENUETELEPHONE:
(818) 849-6705
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 18DATE:
10/14/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Moon Youngsun, Director TIME COMPLETED:
04:35 PM
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On 10/14/2021 at 3:15PM, Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced inspection at Van Nuys Preschool, located at 6260 Tyrone Ave, Van Nuys, CA 91401 for the purpose of following up on the self-reported unusual incident that occurred at the facility on 08/03/2021. The report was received via phone call on 08/05/2021 Unusual Incident/Injury Report (UIR) (LIC 624) was mailed to the El Segundo Child Care Regional Office and received on 08/09/2021. LPA observed 18 children in care with 4 staff and Director Assistant.

According to the Unusual Incident/Injury Report (UIR) that the Department received, on 08/09/2021, around napping time, child#1 shows his private area to child#2. This happened while child#1 was using the toilet located inside of the classroom: yellow.

Based on the facts gathered and interviews conducted, the facility appeared to be in compliance during the incident on 8/03/2021. It does not appear the incident was the result of a Title 22 and/or Health & Safety Code violation. Although Staff #1 was in close proximity to Child #1 when the incident occurred, Staff #1 was unable to prevent the accident. Staff and Director responded immediately to the child's needs and assisted the child to prevent further harm. Parents were notified immediately.

The content of this report was read and discussed in detail with the licensee. The facility appears in compliance per Title 22 regulations. Type A and B deficiencies will not be cited today 7/12/19.

An exit interview was conducted, a copy of this report and notice of site visit provided to the licensee.
SUPERVISORS NAME: Peter Flores
LICENSING EVALUATOR NAME: Denise Miranda
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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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