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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020303
Report Date: 05/24/2024
Date Signed: 05/24/2024 01:48:05 PM

Document Has Been Signed on 05/24/2024 01:48 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:PARA LOS NINOS EARLY HEAD START:VINEFACILITY NUMBER:
198020303
ADMINISTRATOR/
DIRECTOR:		ANGELA CAPONEFACILITY TYPE:
850
ADDRESS:1147 VINE STTELEPHONE:
(213) 250-4800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 40TOTAL ENROLLED CHILDREN: 44CENSUS: 19DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Liliana Rubio, Area Supervisor TIME VISIT/
INSPECTION COMPLETED:
02:25 PM
NARRATIVE
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Licensing Program Analysts (LPA) Staicy Perry conducted an unannounced case management inspection. Upon arrival LPA met with Area Supervisor, Liliana Rubio. Area Supervisor guided LPA on a tour of the facility. The purpose of the inspection was to obtain additional information from the facility regarding an incident reported to the regional office. Census was taken. LPA observed 19 children and 6 staff at the time of inspection. Facility operation hours are Monday to Friday from 8:00AM to 4:30PM. Per Site Supervisor, there are currently 44 enrolled in the program.

The department received an incident report via email from this facility on Friday, May 10, 2024 2:37 PM for an incident that occurred at the facility on May 09, 2024 involving an child left in the outside play yard unattended while in care.

During the inspection LPA conducted (1) staff interview regarding the incident. LPA obtained documentation in the form of facility roster, Parent Handbook, video footage of the incident via email, Child Supervision Record for 5/9/2024, Internal investigation documents, (6) Declarations LIC 855 form, C#1 Identification form and photos.

During the visit LPA Perry observed the Toddler outdoor play yard where C#1 was left unattended. Based on video footage obtained and reviewed, it was determined that C#1 was left unattended in the toddler play yard. S#2 and S#3 were observed to be gathering all the children to transition the children inside. Once S#2 and S#3 gathered the children they then proceeded to walk out of the gate. S#3 was observed to go back into the play yard to grab her clip board and box of materials then proceeded to exit without noticing C#1. Two minutes later, from the right-hand side of the video C#1 appeared and was walking in the play yard with a toy tambourine then three minutes and eleven second later, S#4 S#5 that was in the infant play yard noticed C#1 and immediately took the child and called for assistance.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PARA LOS NINOS EARLY HEAD START:VINE
FACILITY NUMBER: 198020303
VISIT DATE: 05/24/2024
NARRATIVE
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Staff interviewed stated that C#1 was left unattended on the toddler play yard on 5/9/2024 at approximately 11:00am. All staff disclosed that child was left for approx. 5 minutes. Staff #1 stated that parents were notified verbally on 5/10/2024 during drop off time. S#1 also stated that authorized representative that picked up C#1 on 5/9/2024 was notified at pick up time. Per Area Supervisor, no incident report was provided to parents.

Based on observations and information obtained during interviews conducted with staff, review of all documents provided to LPA Perry during visit. LPA Perry determined that on May 09, 2024, in the toddler play yard, two staff were observed to leave the play yard and transition the children indoors when C#1 was left outside. LPA Perry observed the video footage and determined the child to be unattended for 5 minutes and 11.40 seconds which poses an immediate risk to the children in care. Based on interviews/declarations neither teacher were aware that a child was missing until class was sitting for lunch. C#1 was seen by S#4 and S#5 who were in the infant play yard that is besides the toddler play yard.

Based on observations and information obtained during this investigation and records reviewed, the following deficiencies listed on the attached LIC809 deficiencies page are being cited in accordance with California Code of Regulations, Title 22. Deficiency that are being cited need to be cleared to protect the children’s health & safety.

ONE (1) Type A - 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 Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Site Supervisor was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with Area Supervisor Lilliana. Appeal rights were issued and discussed.

SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/24/2024 01:48 PM - It Cannot Be Edited


Created By: Staicy Perry On 05/24/2024 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: PARA LOS NINOS EARLY HEAD START:VINE
FACILITY NUMBER: 198020303

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/31/2024
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 site supervisor, they will conduct a staff meeting to review supervision 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, declarations and documents obtained, facility did not ensure supervision was maintained at all times at the facility. S#1 and S#2 were observed to leave C#1 in the outside toddler play yard, which posed and immediate risk to the health, safety, and personal rights of children in care.
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of what supervision is in the childcare center. Site Supervisor will submit staff meeting agenda, signatures form acknowledging each staff members attendance, and copies of the video’s summaries, to LPA by POC date. Site Supervisor on 5/10/24 has implemeted a face to name recongnition system which s documentted on a LIC 855 form. LPA observed implementation during visit.

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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 Guangorena
LICENSING EVALUATOR NAME:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024


LIC809 (FAS) - (06/04)
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