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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020303
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:31:16 PM

Document Has Been Signed on 09/24/2024 01:31 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: 27CENSUS: 20DATE:
09/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Petra Cervantes, Early Head Start Education Coordinator and Liliana Rubio, Site Supervisor. TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst, (LPA) Staicy Perry conducted an unannounced Case Management Inspection. LPA Perry met with Petra Cervantes, Early Head Start Education Coordinator and Liliana Rubio, Site Supervisor. There were 20 children and 8 staff present. The purpose of this visit is to follow up on an incident reported to the Department on 9/17/2024. During course of the inspection, LPA was taken on a tour of the facility. All teacher/child ratios were met and criminal record clearance for staff was verified.

The department received an incident report from this facility on Tuesday, September 17, 2024 for an incident that occurred at the facility on September 16, 2024 involving a child who ingested an unknown substance that leaked out of a sensory ball causing C#1 to vomit.

During the inspection LPA conducted (3) staff interview regarding the incident. LPA obtained documentation in the form of facility roster, children’s roster, photos, declarations, and other documents were obtained.

According to staff interviews, staff did not observe the incident occur until after child made gagging noise and vomited. Parent was notified. Parent took child to seek emergency medical attention. The following day (9/17/24), the mother provided a medical report. No follow-up is needed. Per, medical report the substance was deemed non-toxic via several exams conducted. Child returned to school on 9/17/24 with no restrictions.
As a precaution the sensory item was removed from the classroom. The children will be reminded to not put anything into their mouths. Sensory items will continue to be available under the supervision of a teacher at structured table time activities.

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.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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: 09/24/2024
NARRATIVE
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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.
CIVIL PENALTY ACCESSED. The facility is being accessed $1000 civil penalties due to same violation occurring twice in one year.

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 Supervisor Lilliana and Petra Cervantes, Early Head Start Education Coordinator. Appeal rights were issued and discussed

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

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/24/2024 01:31 PM - It Cannot Be Edited


Created By: Staicy Perry On 09/24/2024 at 12:53 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: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2024
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 care and Supervison for educators presented by Los Angeles County Office of Education and will provide LPA with certificate once completed.
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Based on interviews, declarations and documents obtained, facility did not ensure supervision was maintained at all times at the facility which caused C#1 to injest an unknown substance, which poses an immediate risk to the health, safety, and personal rights of children in care. CIVIL PENALTY ACCESSED.
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Site Supervisor will submit staff meeting agenda, signatures form acknowledging each staff members attendance, and copies of the certificates to LPA by POC date. Site Supervisor on 9/24/24 sensory item was removed from the classroom. Sensory items will continue to be available under the supervision of a teacher at structured table time activities. 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:Brandi VanOosten
LICENSING EVALUATOR NAME:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024


LIC809 (FAS) - (06/04)
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