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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197495336
Report Date: 01/02/2025
Date Signed: 01/03/2025 08:13:52 AM

Document Has Been Signed on 01/03/2025 08:13 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:VILLAGE PARK PRE-SCHOOL & INFANT CENTERFACILITY NUMBER:
197495336
ADMINISTRATOR/
DIRECTOR:		SHIRANI PERERAFACILITY TYPE:
860
ADDRESS:706 KNOB HILL AVETELEPHONE:
(310) 592-0970
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 3DATE:
01/02/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:51 AM
MET WITH:Elizabeth Cooper - DirectorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 01/02/2025 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, Elizabeth Cooper. LPA then toured the facility and observed 3 infant children in care with 2 staff member (S2 and S3) providing care and supervision.

LPA Castellanos requested the following documents: personnel files.

LPA Castellanos reviewed staff files and the Guardian website and confirmed that staff members, S1 & S2 do not have a current criminal clearance associated to the facility named above. The Guardian Background Check System search results provided no match/association for staff members S1 and S2 in the background checking system to the facility.

Director Cooper and the unassociated staff (S2) both confirmed they have been employed for more than 5 days.

Based on record review and information obtained 2 out of 3 staff members do not have a current criminal clearance associated to the facility named above and no tuberculosis clearance (LIC503) for S2 & S3.

The facility is not complying with the following sections:

101170(e)(2) 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: (2) Request a transfer of a criminal record clearance as specified in Section 101170(f).

101216(g)(1) Personnel Requirements (1) Except as specified in (3) below, good physical health shall be verified by a


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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: VILLAGE PARK PRE-SCHOOL & INFANT CENTER
FACILITY NUMBER: 197495336
VISIT DATE: 01/02/2025
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health screening, including a test for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

There was one deficiency Type A and one Type B 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 Elizabeth Cooper. A copy of this report and appeal rights were discussed and left with Director Elizabeth Cooper, whose signature on this form confirm receipt of these documents.


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SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Cristina Castellanos
LICENSING EVALUATOR SIGNATURE:

DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/02/2025
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Document Has Been Signed on 01/03/2025 08:13 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 01/02/2025 at 12:07 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: VILLAGE PARK PRE-SCHOOL & INFANT CENTER
FACILITY NUMBER: 197495336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/03/2025
Section Cited
CCR
101170(e)(2)

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101170(e)(2) 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: (2) Request a transfer of a criminal record clearance...
This requirement is not met as evidenced by:
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Director agrees to have Staff 1 & Staff 2 cleared and associated to facility before 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, 2 out of 3 staff members (S1 & S2)do not have a current criminal clearance associated to the facility named aboved, 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: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


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Document Has Been Signed on 01/03/2025 08:13 AM - It Cannot Be Edited


Created By: Cristina Castellanos On 01/02/2025 at 12:16 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: VILLAGE PARK PRE-SCHOOL & INFANT CENTER
FACILITY NUMBER: 197495336

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/03/2025
Section Cited
CCR
101216(g)(1)

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Personnel Requirements 101216(g)(1)... physical health shall be verified by a health screening, including a test for tuberculosis, ... seven days after employment or licensure.

This requirement is not met as evidenced by:
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Director agrees staff shall not return to the facility until a copy of the required documentation is submitted to LPA via email by POC due date.
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Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 3 personnel files missing LIC503 and TB clearance, 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: 01/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/02/2025


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