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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011689
Report Date: 08/27/2024
Date Signed: 08/27/2024 03:01:01 PM

Document Has Been Signed on 08/27/2024 03:01 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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. ANNE'S EARLY LEARNING CENTERFACILITY NUMBER:
198011689
ADMINISTRATOR/
DIRECTOR:		MARIA ELENA MEDINAFACILITY TYPE:
830
ADDRESS:151 N. OCCIDENTAL BLVD.TELEPHONE:
(213) 381-2931
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY: 63TOTAL ENROLLED CHILDREN: 52CENSUS: 38DATE:
08/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Ana Marquardt, Associate Director of EducationTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Staicy Perry conducted a Case Management-Deficiencies visit on 8/27/24 to address deficiencies revealed during a complaint investigation. A COVID risk assessment was conducted. LPA met with Ana Marquardt, Associate Director of Education, Eloise Lopez Gonzalez, Lead Teacher, Ruben Garango, Director of Inter-disciplinary services and Justine Francisco, Director of Education who guided LPA on a tour of the facility and to whom the reason for the visit was explained. LPA observed 38 children and 17 staff present at the facility during this inspection.

On 8/23/24 LPA Perry visited the facility to conduct a complaint inspection for the preschool license. Staff interviews and documents received during the complaint investigation revealed the incident involving a child who was left unsupervised which poses an immediate health and safety risk to the children in care, and staff did not report incident which poses a potential health and safety risk for the children in care, occurred at the above licensed facility. Per interviews it was disclosed that child was left unsupervised for an undisclosed amount of time and the incident was not reported to the department.

LPA Perry also obtained several documents, including but not limited to, a copy of the Facility Roster (LIC 9040), Personnel Report (LIC 500), sign in and out sheet, and Incident Report. LPA did review facility file and records and it was determined that the incident was not reported to the department.

Based on staff interviews, records review, and observations the following (1) TYPE A deficiency listed on the following page was observed by the LPA and is being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809-D for citation. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon their return. A copy of this report shall also be provided to the parent/guardian of any newly

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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 08/27/2024 03:01 PM - It Cannot Be Edited


Created By: Staicy Perry On 08/27/2024 at 02:02 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER
FACILITY NUMBER: 198011689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/13/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.This requirement was not met as evidenced by:
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Per Administrator, a staff meeting will be conducted to review supervsion and discussing how supervision can be maintained at all times. Staff will watch video titled Supervising Children in Child Care Centers on www.childcarevideos.org and provide summaries of their understanding
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Based on interviews, observations and record review, a child was left unattended for an undisclosed amount of time in the hallway, which poses an immediate risk to the health, safey, and personal rights of children in care.
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 of what supervision is in the child care center. Administrator will submit staff meeting agenda, signatures form acknowledging each staff members attendance, and copies of the videos summaries, to LPA by POC date. Staff will conduct face to name counts every 15 mintues to ensure how many children are in care at all times.

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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:Brandi VanOosten
LICENSING EVALUATOR NAME:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


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Document Has Been Signed on 08/27/2024 03:01 PM - It Cannot Be Edited


Created By: Staicy Perry On 08/27/2024 at 02:11 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER
FACILITY NUMBER: 198011689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/06/2024
Section Cited
CCR
101212(d)(1)(c)

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Upon the occurrence, during the operation of the child care center of any of the events specified *** a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.**a written report** shall
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Administrator submitted a Unusual Incident/Injury report during today's visit, via phone as well as submitted the written report on 8/27/2024 @ 3:00pm.
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be submitted to the Department within seven days***
This evidence was not made by, an incident occured at the above facility on 7/26/2024 and was not reported to the Department within the required 24 hours. The Administrator did not submit a written report within the required 7 days. This poses a potential risk to the health and safety of children 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 08/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/27/2024


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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER
FACILITY NUMBER: 198011689
VISIT DATE: 08/27/2024
NARRATIVE
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enrolled child for the next 12 months. A signed Acknowledgement of Receipt (LIC9224) shall be in each child’s file, acknowledging receipt and (1) TYPE B deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


An exit interview was conducted, and a copy of this report was provided to Ana Marquardt, along with Appeal Rights.

SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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