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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495256
Report Date: 09/09/2024
Date Signed: 09/09/2024 02:14:18 PM

Document Has Been Signed on 09/09/2024 02:14 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 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: DATE:
09/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:20 PM
NARRATIVE
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On 09/09/2024 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. During today’s inspection there were 6 children, 1 adult staff and Director Candice Wong providing care and supervision.

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



Personnel Records 101217(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

There was one (1) deficiency 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.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Director Wong. A notice of site visit was given and must remain posted for 30 days. 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: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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Document Has Been Signed on 09/09/2024 02:14 PM - It Cannot Be Edited


Created By: Cristina Castellanos On 09/09/2024 at 12:10 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: 09/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2024
Section Cited
CCR
101217(d)

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Personnel Records 101217(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
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Director agrees to submit a copy of E. Wong's complete personnel file via emai 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, 1 out of 2 personnel files records were not available for review, 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: 09/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2024


LIC809 (FAS) - (06/04)
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