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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020953
Report Date: 03/04/2024
Date Signed: 03/04/2024 01:01:53 PM

Document Has Been Signed on 03/04/2024 01:01 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:BRELLA HOLLYWOODFACILITY NUMBER:
198020953
ADMINISTRATOR:WILLIAMS, DARIENFACILITY TYPE:
850
ADDRESS:909 N. ORANGE DR.TELEPHONE:
(213) 300-5962
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: DATE:
03/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Alessandra Pinheiro, DirectorTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced Case Management inspection. Upon arrival LPA met with Director Alessandra. Director guided LPA on a tour of the facility. The purpose of the inspection is to follow up on an Unusual Incident reported to the regional office. Census was taken. LPA observed 32 children and 6 staff at the time of inspection. This is a preschool program and hours of operation are M-F 8:00am-5:00pm.

The department received an incident report via email from this facility on 02/08/2024 for an incident that occurred at the facility on 02/06/2024 involving an incident requiring medical attention while in care.

During the visit LPA Perry observed the climbing structure in the classroom where C#1 fell from (pictures were taken.) during prior visit. LPA did observe all the classrooms in today’s inspection and all climbing structures have been removed. Based on manufactures information, it was determined that climbing structure is not age appropriate. Manufacture label discloses that the piece of climbing structure can be used in 3 different ways and to select the variation that fits the child’s needs depending on the needs of the child. Manufacture also states not to leave the children unattended while climbing structure is in use.

Based on observations and information obtained during interviews conducted with four (4) staff,(1) parent and photos of the incident, LPA Perry determined that on February 6, 2024, in the Lilac Room C#1 fell off the climbing structure. Two staff were present in the Lilac Room at the time of the incident. One staff was at the table near the entrance door of the classroom doing an activity with the children and the other staff was occupied doing a diaper change in the diaper changing area. Based on interviews with both staff present neither were positioned close enough to attend to C#1 while child one was climbing the structure, which resulted in C#1 obtaining a fracture on the leg.

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SUPERVISORS NAME: Claudia Guangorena
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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: BRELLA HOLLYWOOD
FACILITY NUMBER: 198020953
VISIT DATE: 03/04/2024
NARRATIVE
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Climbing struct is observed to be 4 feet and 58 inches in height. Although the classroom has cameras, Director informed LPA Perry that she would not be able provide the department with the footage due to technical difficulties. Director Alessandra signed a declaration explaining why video footage cannot be provided to the department.

Additionally, C#1 attended the facility the following day February 7, 2024, and observations were made by teachers that C#1’s behavior changed. C#1 refused to walk the whole day and seemed to be in pain. Staff stated that parent was notified at pick up at around 5pm that child was refusing to walk and shaking their leg while standing showing symptoms of changes in the child’s daily behavior.

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.

TWO (2) 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. Licensee/Director 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.

A notice of site visit was given and must remain posted for 30 days. Acknowledgement form was provided to director to provide to parents.

Exit interview conducted and report was reviewed with Director Alessandra. Appeal rights were issued and discussed.





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

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/04/2024 01:01 PM - It Cannot Be Edited


Created By: Staicy Perry On 03/04/2024 at 11:47 AM
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: BRELLA HOLLYWOOD
FACILITY NUMBER: 198020953

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/04/2024
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 Director, 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 interview, licensee did not ensure supervision was maintained at all times at the facility. Based on interviews with S#2 and S#4 neither were positioned close enough to attend to C#1 while child one was climbing the structure, which resulted in C#1 obtaining a fracture on the leg, 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. Director will submit staff meeting agenda, signatures form acknowledging each staff members attendance, and copies of the video’s summaries, to LPA by POC date. Director will remove the climber in Lilac classroom and sign declaration by POC date of 3/15/2024.
Type A
03/04/2024
Section Cited
CCR101223(a)(2)

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101223 Personal Rights states (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. This requirement was not met as evidenced by
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Per Director she will have a staff meeting to discuss child’s personal rights and will watch personal rights video on https://ccld.childcarevideos.org/ Director and staff will write a declaration with plans implemented for this not to happen again. Declarations will be submitted to LPA via email by POC date.
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Based on manufactures information, it was determined that facility utilized the climbing structure outside of the manufacturer's instructions. As well as not treating the child healthful. This is an immediate 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:Claudia Guangorena
LICENSING EVALUATOR NAME:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024


LIC809 (FAS) - (06/04)
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