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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021223
Report Date: 10/25/2024
Date Signed: 10/25/2024 02:03:38 PM

Document Has Been Signed on 10/25/2024 02:03 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:PATHWAYS LAFACILITY NUMBER:
198021223
ADMINISTRATOR/
DIRECTOR:		LAKENDRA WILLIAMSFACILITY TYPE:
830
ADDRESS:1 GATEWAY PLAZATELEPHONE:
(213) 427-2700
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY: 36TOTAL ENROLLED CHILDREN: 23CENSUS: 15DATE:
10/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:31 AM
MET WITH:Lakendra Williams, Site Supervisor & Shannon Huston, Director of Family of Child Care Provider ServicesTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On October 25, 2024, Licensing Program Analyst (LPA) Staicy Perry conducted an unannounced case management inspection to follow up with an incident that was reported to the department. LPA met with La Kendra Williams, Site Supervisor and Shannon Huston, Director of Family of Child Care Provider Services, who guided LPA on a tour of the facility. This facility is located on the premises of Union Station Los Angeles and operates out of 2 levels (lower and upper). There is also a preschool program (198021224) that operates on the same premises as the infant program.

On 10/17/2024, it was reported to the department that on 10/14/2024, C#1 was walking up and down gross motor ramp (Step 2 Unicorn up and down roller coaster) located in the indoor/ outdoor room during their scheduled playtime. As C#1 was walking up, C#1 tripped over and hit mouth on the edge of ramp, causing C#1 to bite tongue and cause mild bleeding. Parent was notified and C#1 was later picked up and was taken to seek emergency medical treatment and C#1 has not yet returned. Per Shannon, parent reported that C#1 is doing fine. S#1 and S#2 stated that the incident was observed. Per S#1 and S#2, the incident happened so fast it was unable to be prevented. The incident was not reported to the Department within the 24-hour period. Per Director Shannon Houston report was not called into the department on the day of the incident, due to miss communication and department error a declaration was obtained and a technical was provided.

LPA Perry did obtain and review video footage from facility. Based on information obtained, interviews and video footage, there were no corroborating information to determine that there was a lack of supervision during the incident. However, the Step 2 Unicorn Up & Down Roller Coaster was determined via investigation on product description that toy was not age-appropriate for children under the age of 2.

During today’s inspection, interviews were conducted, video footage was obtained, and other documentation was reviewed and obtained, C#1 incident on 10/14/2024 was observed and first aid was provided, and it was determined to be an accident. However, the toy where C#1 fell from was determined not to be age
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Staicy Perry
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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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Document Has Been Signed on 10/25/2024 02:03 PM - It Cannot Be Edited


Created By: Staicy Perry On 10/25/2024 at 12:29 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: PATHWAYS LA
FACILITY NUMBER: 198021223

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/08/2024
Section Cited
CCR
101239(m)

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(m) All play equipment and materials used by children shall be age-appropriate.

This requirement is not met as evidenced by:

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During inspection LPA Perry observed toy removed and placed in preschool yard. Per Director and Site Supervisor they will review all toy label descriptions for age approperiateness. Director and Site Supervisor will submit plan in writing on LIC 855 by POC date to LPA Perry.
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Based on observation, the licensee did not comply with the section cited above, toy in the infant indoor outdoor play yard was not observed to be age approperiate, which poses a potential health, safety or personal rights risk to persons 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:Staicy Perry
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


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: PATHWAYS LA
FACILITY NUMBER: 198021223
VISIT DATE: 10/25/2024
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appropriate. LPA did advise, Director Shannon and Site Supervisor La Kendra, to review product descriptions prior to placing then in the classrooms. During inspection, LPA Perry observed Step 2 Unicorn up and down roller coaster removed and placed in their preschool yard, which is a suitable age group. Per, director Shannon, all toys will be reviewed for age appropriateness.

The deficiency listed on the following page was observed by LPA Perry and is being cited in accordance with California Code of Regulations Title 22. One Type B deficiency is being issued today for regulation 101239
Fixtures, Furniture, Equipment and Supplies (m) All play equipment and materials used by children shall be age appropriate. Please see attached LIC 809-D for citation.

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

Exit interview conducted and report was reviewed with the facility representatives Shannon Huston and La Kendra Williams.

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

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
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