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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495256
Report Date: 10/28/2024
Date Signed: 10/29/2024 09:17:27 AM

Document Has Been Signed on 10/29/2024 09:17 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: 4DATE:
10/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:01 PM
MET WITH:Candice Wong - DirectorTIME VISIT/
INSPECTION COMPLETED:
02:50 PM
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On 10/28/2024 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 Castellanos was greeted by Facility Director, Candice Wong and Assistant E. Wong in the Lobby. LPA then toured the facility and observed 3 children in care with 1 staff member (S3) providing care and supervision. Shortly after at approximately 09:19am a child was dropped off in the infant room.



LPA Castellanos requested the following documents: personnel file.

LPA Castellanos reviewed staff file and Guardian and confirmed that staff (S3) does not have a current clearance associated to the facility. Guardian Background Check System search results provided the following message: No applicants that match your search were found in the background checking system. LPA Castellanos additionally requested if a copy of form LIC 9163 Request for Live Scan Service – Community Care for uncleared staff (S3) could be provided. Director then stated she did not have a copy of the Live Scan form.

Director Wong and the uncleared staff (S3) both confirmed she has been employed for more than 5 days.

Based on observation, record review and information obtained 4 children were left under the supervision of an uncleared staff (S3) during today’s visit from 9:00am to 10:54am. The facility is not complying with section 101170(e)(1) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department.

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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2024
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: 10/28/2024
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There was one deficiency Type A 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. As well as a Civil Penalty Assessment - Caregiver Background Check was given.

Effective January 1, 2009, all licensees must comply with Assembly Bill (AB) 978. Assembly Bill 978 requires the assessment of an immediate civil penalty for designated serious violations at community care facilities. Effective January 1, 2007, the licensee must comply with Assembly Bill 633 as follows: Copies of any licensing report that documents a Type A citation - this includes facility visits and substantiated complaint investigations. Copies of any licensing documents pertaining to a noncompliance conference between licensing management and licensees. Copies of a summary of an accusation indicating the Department’s intent to revoke the facility’s licenses. Copies of any of the above licensing documents the licensee has received in the prior 12 months shall be provided to parents/guardians of newly enrolling children. The licensee shall keep verification of receipt in each child’s file at the facility as proof of compliance (LIC 9224).

Upon receipt of this report, the Licensee shall post the Notice of Site Visit. 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.

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

DATE: 10/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/29/2024 09:17 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 10/28/2024 at 01:14 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: 10/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/30/2024
Section Cited
CCR
101170(e)(1)

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101170(e)(1) Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working... in a licensed facility:
(1) Obtain a California clearance or a criminal record exemption as required by the Department...
This requirement is not met as evidenced by:

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Director agrees to have Staff #3 cleared and associated to facility before Staff 3 is allowed back in the facility. The Director will notify LPA via email when it has been completed.
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Based on observation, record review and information obtained the facility did not comply with the section cited above, 4 children were left under the supervision of an uncleared staff (S3) during today’s visit from 9:00am to 10:54am., 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: 10/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2024


LIC809 (FAS) - (06/04)
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