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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021116
Report Date: 08/23/2024
Date Signed: 08/23/2024 01:22:59 PM

Document Has Been Signed on 08/23/2024 01:22 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:MARSHALL EARLY EDUCATION CENTERFACILITY NUMBER:
198021116
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, SANDRAFACILITY TYPE:
830
ADDRESS:1817 JACKSON AVENUETELEPHONE:
(626) 307-3396
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY: 76TOTAL ENROLLED CHILDREN: 76CENSUS: 43DATE:
08/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Laura Hernandez - Early Care Education ManagerTIME VISIT/
INSPECTION COMPLETED:
01:42 PM
NARRATIVE
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Licensing Program Analyst (LPA) Nolan Tcheng conducted an unannounced Case Management inspection for the purpose of following up on an incident reported to the Department on 08/16/2024. Upon arrival at 10:40pm, LPA met with Early Care and Education Manager Laura Hernandez, to whom the purpose of the inspection was explained. Tour of the facility was provided. There were children present during the time of inspection.

Census was taken. There were 43 children with 14 staff members.

On 08/15/2024, a child enrolled at the facility took part in program provided PM snack. Child is enrolled with an allergy that was known to the facility since child's enrollment. Snack that was provided to the child had an ingredient that caused an allergic reaction to the child. Parent was informed and no further medical evaluation was received, per parent. Staff reviewed snack label that showed the allergen was present.

During today's inspection, interview was conducted with three staff members. Documentation in the form of children allergy list and snack menus were obtained. Staff stated that the snack that was provided was from the Garvey School District. Staff interviews corroborated that the food was provided to the child via the district food service program and sent as a substitute snack for the child involved. Child was provided a substitute snack due to another allergen in the regularly scheduled snack. Per staff, the child had eaten the substitute snack before on site and there had been no issue. Child has since returned to the facility.

Due to facility program providing a snack with a known allergen to the child with the documented allergy, the facility has violated the child's Personal Rights. A citation is being provide to the facility during today's inspection.

Per facility, they have conducted a training since the incident and have implemented documentation procedures for food that comes in and is served to children with allergies. Letter of correction clearance provided on this date.

REPORT CONTINUES PAGE 1 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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: MARSHALL EARLY EDUCATION CENTER
FACILITY NUMBER: 198021116
VISIT DATE: 08/23/2024
NARRATIVE
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The deficiencies listed on the following page was observed by the LPA and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and need to be cleared to protect the children’s health & safety.

Upon receipt of this report, the Licensee shall post the Notice of Site visit and any licensing report documenting a type “A” deficiency. The report and the Notice of Site visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. 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 was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the licensee.

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

Exit interview conducted and report was reviewed with the Early Care and Education Manager Laura Hernandez, at 1:18pm. Plan of correction was discussed and copy of Report provided.

END OF REPORT PAGE 2 of 2

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/23/2024 01:22 PM - It Cannot Be Edited


Created By: Nolan Tcheng On 08/23/2024 at 12:47 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: MARSHALL EARLY EDUCATION CENTER
FACILITY NUMBER: 198021116

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2024
Section Cited
CCR
101223(a)(2)

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101223(a)(2) Personal Rights
(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.


This requirement is not met as evidenced by:
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Per Manager, they have conducted a training with staff and have now began logging all foods that the child is provided from the food service program, every meal. LPA obtained training agenda and staff attendance sheet. Copy of food log for child with allergies was obtained. Letter of correction was provided
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Based on record review and interview, licensee did not ensure Child #1 was provided a snack safe from known allergens, resulting in child having an allergic reaction. This was an immediate risk to the health, safety, and personal rights of children in care.
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to the facility on this date.

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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:Ana Chico
LICENSING EVALUATOR NAME:Nolan Tcheng
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2024


LIC809 (FAS) - (06/04)
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