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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495256
Report Date: 08/13/2024
Date Signed: 08/14/2024 08:32:05 AM

Document Has Been Signed on 08/14/2024 08:32 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
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHILDREN OF OUR SAVIORFACILITY NUMBER:
197495256
ADMINISTRATOR/
DIRECTOR:		OLUBUKOLA SALAKOFACILITY TYPE:
830
ADDRESS:6705 W 77TH STREETTELEPHONE:
(310) 215-3166
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY: 38TOTAL ENROLLED CHILDREN: 38CENSUS: 5DATE:
08/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:41 PM
MET WITH:Candice Wong - Director TIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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On 08/13/2024 Licensing Program Analyst (LPA) Cristina Castellanos conducted an unannounced case management inspection for the purpose of ensuring the standards are being met in accordance with California Tittle 22 Regulations and California Health and Safety Codes.

LPA met with Director Candice Wong and toured the facility both indoors and outdoors. During today’s inspection there were 5 children, 1 adult staff and Director Candice Wong providing care and supervision.

Based on observation, the facility did not comply with the following regulations:

Staff-Infant Ratio 101416.5(b) From 1:43 p.m. to 02:00 p.m. LPA Castellanos observed staff E. Wong providing care and supervision for 5 infants in the infant classroom; two of which were awake and the other three infants were napping.

Infant Care Center Sleeping Equipment 101439.1(f) At approximately 1:10pm LPA Castellanos observed a loose blanket and a plushy blanket inside the crib with the sleeping infant (C2).

Infant Care Activities 101430(a)(3)(C) & 101430(a)(3)(A) Around 1:09 p.m. in the napping area LPA Castellanos observed two infants (C4 & C1) out of 4 sleeping infants with oversized sleeping sacks. Additionally, at 1:10 p.m. LPA Castellanos observed infant (C1) not sleeping on her back.

Infant Care Food Services 101427(j) & 101427(c) At 1:15 p.m. LPA Castellanos observed all infant bottles and containers on the classroom’s counter not to be labeled with the infants’ name. At approximately 3:49 p.m. LPA Castellanos observed infant (C3) drinking out of another infant’s bottle (C2).

There were six (6) deficiencies cited during today’s visit in accordance with the California Code of Regulations, Title 22, Division 12, and Chapter 1. See LIC 9099-D for additional information.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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 RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CHILDREN OF OUR SAVIOR
FACILITY NUMBER: 197495256
VISIT DATE: 08/13/2024
NARRATIVE
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Upon receipt of this report, the Director shall post the Notice of Site Visit and any Licensing report documenting a Type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 Acknowledgment of Receipt (LIC9224) form must be maintained in each child’s file immediately upon receipt from parent. The Director was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

An exit interview was conducted, and Plan of Correction was reviewed and developed with the Director Wong. A copy of this report and appeal rights were discussed and left with the Director, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 08/14/2024 08:32 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 08/13/2024 at 05:08 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: CHILDREN OF OUR SAVIOR
FACILITY NUMBER: 197495256

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
101416.5(b)

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Staff-Infant Ratio 101416.5(b) There shall be a ratio of one teacher for every four infants in attendance.

This requirement is not met as evidenced by:
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Director agree to develop and implement
a plan to make sure that they are compling with the capacity requirements throughout the day for an Infant Facility.
Director will submit the developed plan in
writing to LPA via email by the POC due date.
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Based on observation, the facility did not comply with the section cited above, between 1:43pm to 2:00pm LPA observed only one staff providing care and supervision for 5 infants; two of which were awake and the other three napping, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type A
08/30/2024
Section Cited
CCR101439.1(f)

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Infant Care Center Sleeping Equipment 101439.1(f) Cribs shall be free from all loose articles and objects, including blankets and pillows.

This requirement is not met as evidenced by:
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Director agrees to go over the Safe Sleep Regulations with staff. Additionally agrees to no longer have any loose articles and objects inside the crib. Director will submit signed statements of understanding from all staff to LPA via email by POC due date.
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Based on observation, the facility did not comply with the section cited above, at 1:10pm LPA Castellanos observed a loose blanket and a plushy blanket inside the crib with the sleeping infant (C2), 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2024 08:32 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 08/13/2024 at 05:23 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: CHILDREN OF OUR SAVIOR
FACILITY NUMBER: 197495256

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
101430(a)(3)(C)

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Infant Care Activities 101430(a) Notwithstanding Section 101230, the following shall apply:(3) All infants shall be given the opportunity to sleep without...(C) An infant shall not be swaddled while in care.

This requirement is not met as evidenced by:
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Director agrees to no longer swaddled infants in care. Additionally will speak to parents to provide fitting and comforting clothing for infant in care. Additionally agrees to have all staff watch the following webinar:
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Based on observation, the facility did not comply with the section cited above, at 1:09 p.m. in the napping area LPA observed two infants (C4 & C1) out of 4 infants sleeping with oversized sleeping sacks, which poses/posed a potential health, safety or personal rights risk to persons in care.
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https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep will submit a written summary of what was covered to LPA via email by POC due date.
Type A
08/30/2024
Section Cited
CCR101430(a)(3)(A)

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Infant Care Activities 101430(a) (a) Notwithstanding Section 101230, the following shall apply: (3) All infants shall be given the opportunity to sleep without... (A) Staff shall place infants up to 12 month of age on their backs for sleeping
This requirement is not met as evidenced by:
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Director agrees to submit a written napping plan regarding Safe Sleep to prevent 12 month olds from not sleeping on their backs. Director will submit plan to LPA via email by POC due date.
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Based on observation, the facility did not comply with the section cited above, at 1:10pm LPA observed infant (C1) not sleeping on her back, 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 08/14/2024 08:32 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 08/13/2024 at 05:32 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: CHILDREN OF OUR SAVIOR
FACILITY NUMBER: 197495256

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2024
Section Cited
CCR
101427(j)

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Infant Care Food Service 101427(j) Bottles, dishes and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.
This requirement is not met as evidenced by:
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Director agrees to make sure parents and staff are informed that all infant bottles and containers shall be labeled with the infant's name here on. The director will submit pictures of the correction to LPA via email by POC due date.
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Based on observation, the facility did not comply with the section cited above, at 1:15 p.m. LPA observed all the infant’s bottles and containers on the classroom’s counter not to be labeled with the infants’ name, which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
08/30/2024
Section Cited
CCR101427(c)

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Infant Care Food Service 101427(c)The infant shall be fed in accordance with the individual plan.

This requirement is not met as evidenced by:
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Director agrees to submit a written statement that infants shall be fed in accordance with their individual feeding plan to LPA via email by POC due date.
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Based on observation, the facility did not comply with the section cited above, at 3:49 pm LPA observed infant (C3) drinking out of another infant’s bottle (C2), 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:Claudia Escobedo
LICENSING EVALUATOR NAME:Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:
DATE: 08/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2024


LIC809 (FAS) - (06/04)
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