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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020576
Report Date: 06/26/2023
Date Signed: 06/26/2023 03:13:19 PM

Document Has Been Signed on 06/26/2023 03:13 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BELL TOWER SCHOOLFACILITY NUMBER:
198020576
ADMINISTRATOR:CRISTINA A. SPIKFACILITY TYPE:
850
ADDRESS:5561 HUNTINGTON DR N.TELEPHONE:
(323) 576-2086
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY: 96TOTAL ENROLLED CHILDREN: 48CENSUS: 43DATE:
06/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Cristina A. Spik TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 05/26/2023. LPA met with Director, Cristina Spik, who guided LPA on a tour of the facility. LPA conducted interviews and obtained documentation during this visit.

The incident that occurred on Friday, May 26, 2023, was reported to the Department on Tuesday, May 30, 2023. Monday, May 29, 2023 was a legal holiday. The facility reported the incident in a timely manner.

The incident which occurred consisted of C1 being given a food by with a known allergy by S1. The child began to have an allergic reaction on site.

Based on the information obtained from staff interviews and records obtained, staff gave child a food with a known allergy. The child's allergies were listed on the LIC 701, Physician's Report dated 08/26/22, Child's Preadmission health history LIC 702, Child's Application for Enrollment and Authorization & Instructions for Dispensing Medication. It was found that the allergy was also posted in the classroom. The facility was in violation of child #1's Personal Rights, each child shall be accorded safe, healthful and comfortable accommodations.




*REPORT CONTINUES ON NEXT PAGE
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE: DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/26/2023
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 06/26/2023 03:13 PM - It Cannot Be Edited


Created By: Judy Mora On 06/26/2023 at 12:34 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: BELL TOWER SCHOOL
FACILITY NUMBER: 198020576

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2023
Section Cited
CCR
101223(a)(2)

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Personal Rights
To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement was not met as evidenced by the incident that occurred on 05/26/23, when C1 was given a food item with a known
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Director states a training was completed with staff on 06/01/23. Staff attendance was provided to LPA. All food will be reviewed when being brought into the facility. Statement was obtained.
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allergy in it. The child began to have an allergic reaction at the facility. This was an immeidate risk to the health and safety of the child 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 Guangorena
LICENSING EVALUATOR NAME:Judy Mora
LICENSING EVALUATOR SIGNATURE:
DATE: 06/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/26/2023


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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BELL TOWER SCHOOL
FACILITY NUMBER: 198020576
VISIT DATE: 06/26/2023
NARRATIVE
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Upon receipt of this report, the licensee shall post ANY licensing report documenting a type “A” citation. This must remain posted for 30 days during hours of operation. In addition to posting this report, the licensee will also provide copies to the parents of the children in care for up to one year.

A copy of the LIC 9224 - Acknowledgement of Receipt of Licensing Reports was provided to the Director.

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.

The 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 809d.

Deficiency that is being cited needs to be cleared to protect the children’s health & safety.

Exit interview was conducted with Licensee. Appeal rights explained & provided.


*END OF REPORT
SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Judy Mora
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2023
LIC809 (FAS) - (06/04)
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