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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020954
Report Date: 05/08/2023
Date Signed: 05/08/2023 04:37:10 PM

Document Has Been Signed on 05/08/2023 04:37 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:BRELLA HOLLYWOODFACILITY NUMBER:
198020954
ADMINISTRATOR:WILLIAMS, DARIENFACILITY TYPE:
830
ADDRESS:909 N. ORANGE DR.TELEPHONE:
(213) 300-5962
CITY:LOS ANGELESSTATE: CAZIP CODE:
90038
CAPACITY: 36TOTAL ENROLLED CHILDREN: 32CENSUS: 30DATE:
05/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Kimberly Gentle, Assistant Director TIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Mireya García conducted an unannounced Case Management inspection due to an incident that was reported to the Department on March 13, 2023. Due to COVID- 19 precautionary measures were taken, licensing staff present during inspection wore appropriate personal protective equipment. LPA met with Kimberly Gentle, Assistant Director who guided LPA on a tour of the facility. Census was taken.

On March 13, 2023, an unusual incident report was made to the department regarding an incident that involved a child who was left unsupervised in the community room on March 1, 2023. The facility did not report this incident to the Department within the required 24 hours.



Based on information obtained during interviews conducted with four (4) staff, and video footage review of the incident LPA Garcia determined that on March 1, 2023, during transition time from the community room back to the classroom child #1 was left behind by Staff #2 & Staff #3 and was found by Staff #1 who observed child #1 in the community room unsupervised.

REPORT CONTINUES ON NEXT PAGE 1 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: BRELLA HOLLYWOOD
FACILITY NUMBER: 198020954
VISIT DATE: 05/08/2023
NARRATIVE
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Although there were two (2) staff who was present providing care and supervision neither observed child #1 being left behind in community room. Both staff were assisting with transitioning children back into the classroom. Both staff had no knowledge of child #1 being left behind until Staff #1 found child and took child #1 back into the classroom.

LPA Garcia observed the community room where child #1 was left and found. Child #1 did not exit the premises of the facility. During LPA’s review of video footage, it was recorded that on March 1, 2023 Child #1 was left by Staff #2 & Staff #3 at 10:50 a.m., and was found by Staff #1 at 10:51 a.m.

Based on information obtained during this investigation and records review during today’s inspection, the following deficiencies listed on the attached LIC809 deficiencies page are being cited in accordance with California Code of Regulations, Title 22, Division, 12, Chapter 1, Subchapter 02, Section 101429(a)(1) Responsibility for Providing Care and Supervision for infants: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Kimberly Gentle.



END OF REPORT: PAGE 2 OF 2.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Mireya Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/08/2023 04:37 PM - It Cannot Be Edited


Created By: Mireya Garcia On 05/08/2023 at 03:15 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: BRELLA HOLLYWOOD
FACILITY NUMBER: 198020954

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/26/2023
Section Cited
CCR
101429(a)(1)

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101429-Responsibility for Providing Care and Supervision for Infants (a) In addition to Section 101229, the following shall apply: (1) Each infant shall be constantly supervised and under direct visual observation and supervision by a staff person at all times. This requirement is not met as evidenced by:
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Per Assistant Director, staff have implemented Supervision plan to ensure staff are acounting for all children in care at all times including but not limited to transitioning times. A staff training will be conducted to review plan with staff and a copy of the staff agenda/sign in sheet and training material will be scan to LPA Garcia via email by POC due date 5/26/2023
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During LPA’s review of video footage of March 1, 2023, it was recorded that Child #1 was left by Staff #2 & Staff #3 at 10:50 am and was found by Staff #1 at 10:51 am. Staff #2 and Staff #3 interviewed could not account for how this occurred. This poses a potential health and safety risk to children in care.
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Type B
05/26/2023
Section Cited
CCR101212(a)(d)(1)(C)

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101212 Reporting Requirements: (a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following: (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, 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. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. (1) Events reported shall include the following: (C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
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Per Assistant Director facility will conduct training with staff to review reporting requirements. Assistant Director will submit training material; staff sign in sheet and agenda to LPA Garcia via email by POC due date 05/26/2023
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LPA Garcia’s records review and staff disclosures facility failed to report incident that occurred on 03/01/2023 to the Department within the required 24 hours. This poses a potential health and safety risk to 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:Mireya Garcia
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2023


LIC809 (FAS) - (06/04)
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