STATE OF CAI:IIE'A'mfi!Jll\ND HUMAN SERVICES A~~~~:,:'J,."ci::'s~."e"v10es FACILITY EVALUATION REPORT CCLDReglona!Om"',1000CORPOIIATECNTRDR.200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CA 90 CENSUS: 68 CAPACITY: l'YPE DF VISIT: Case Management - Incident UNANNOUNCED MET WITH: Maricela Villalobos and Laura Hernandez FACIUTY NUMBER: FACIUTYTYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 09/19/2014 09:45AM 03:30PM NARRATIVE 1 Ucensing Program Analyst-Complaint Specialist (UPA-CS), Hilda Estrella arrived at St. Anne's Early Learning 2 Center on this day for the purpose of following up on the Unusual Incident Report received in the CCL office 3 on 07/25/14. During the visit CS Estrella met wllh, Assistant Director, Marisela Villalobos and Site Director, 4 Laura Hernandez. 5 6 CS Estrella conducted interviews with multiple children and staff. Children's files were reviewed as well as 7 documentation was provided relevant to the Incident. In addition, pictures were taken. At this time, further 8 investigation is needed. 9 10 While at the facility, CS Estrella discussed Reporting Requirement issues regarding an incident that occurred 11 on or around 08/14/14 regarding a notice that was posted in reference to an exposure to nits for 2 or more of 12 the children at the Center. The Ucenslng Office has not received notice of that incident. It was reported to 13 Public Heallh Department, but was not reported to CCL. 14 15 The following deficiencies were observed or cited In accordance to Title 22 of 1he Ca!lfomla Code of Reaulat!ons and/or 16 Health & Safety Codes on UC809D. 17 18 Upon receipt the Ucensee shall post the Notice of sne Visit. This notice shall be posted where the parents 19 enter and exit the facilny. This notice shall be posted for 30 consecutive days. Failure to maintain posting as 20 required will result in a $100.00 cMI penalty. 21 22 Exit interview was conducted with Assistant Director, Marisela Villalobos and Soo Director, Laura Hernandez appeal rights and procedures explained. 23 24 25 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Hilda Estrella TELEPHONE: (323) 981-2956 LICENSING EVALUATOR SIGNATURE: ~- DATE: 09/19/2014 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2014 ' This report must be available at Child Care and Group Home facllities··for public review for 3 years. LIC809 (FA$)· (06104) Page: 1 or2 LIS055 LICENSING INFORMATION SYSTEM - FACILITY PROFILE DATE: 10/03/14 EVALUATOR: 2213 DO: 33 FAC NBR: 19 8011690 STATUS: LICENSED FAC NAME: ST. ANNE'S EARLY LEARNING CENTER CAPACITY: 0090 FAC ADDR: 151 N. OCCIDENTAL BLVD., LOS ANGELES, CA 90026 FAC MAIL: 151 N. OCCIDENTAL BLVD., LOS ANGELES, CA 90026 FAC TYPE: DAY CARE CENTER CLIENT SERVED: CHILDREN FAC FIRST LICENSED: 07/15/05 APP REC'D: 06/27/05 COUNTY: LOS ANGELES DIRECTOR: LAURA HERNANDEZ PHONE: (213)381-2931 DATE .CAP CHG: 12/07/05 DATE CAP APPR: ANNUAL FEES CURRENT: YES LICENSEE NAME: ST. ANNE'S MATERNITY HOME LIC MAIL: 151 N. OCCIDENTAL BLVD., LOS ANGELES, CA 90026 LIC EFF DATE: 07/15/05 TYPE: NON-PROFIT CORPORATION FAC DUAL IDENTIFIER: N DUAL LICENSE NBR: FCRB: COMMENTS LICENSEE TO SERVE (90) PRESCHOOL CHILDREN AGES 2 UNTIL ENTRY INTO FIRST GRADE. FAC CLOSED DATE: E-MAIL: LAST VISIT DATE: 09/19/14 TYPE: CASELOAD MANAGEMENT LAST DEFERRED VISIT DATE: TYPE: SUPPLEMENTARY PERSONAL HISTORY: 000 REQUIRED VISIT: Y R = MENU, Y = DATES, F = SUMMARY, H = PAYMENT HISTORY, E= EMERGENCY Enter> STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMSION FACILITY EVALUATION REPORT (Cont) CCLO Regional Otnce, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK, CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number Type B 09/26/2014 Section Cited 101212(d)(1 )(E) Type B 10/03/2014 Section Cited 101212{d) FACIUTY NUMBER: 198011690 VISIT DATE: 09/19/2014 DEFICIENCIES 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) 1 2 A report shall be made to the Department within 24 3 hours of the occurrence of any unusual Incident as 4 5 specified. Events reported shall include the 6 following: Epidemic outbreaks. During the vlsltlt 7 was determined that on or around OB/14/14the Reporting Requirement: 8 facility was aware of a Nit exposure to 2 or more 9 children and failed to cail in the incident to CCL 10 within the required 24 hour. 11 12 13 14 8 9 10 11 12 13 14 1 Reporting Requirements. 2 3 A written report containing the Information specified 4 in (d)(2) below shall be submitted to the 5 Department within seven days following the 6 occurrence of such event. During the visit it was 7 determined that on or around 08/14/14the faclltty 1 2 3 4 5 6 8 was aware of a Nit exposure to 2 or more children 9 and failed to submit the wrttlen incident to CCL 10 within the required 7 day pertod. 11 12 13 14 B 9 10 11 12 13 14 Facility staff will ensure 1o report exposure/ou1break of two or more children in care by phone on the day lhat they find ou1 of the ou1break. A plan of correction will be submftted to CCL no later than 09/26/14. Site Director Indicates will be submitting a written appaal within I 0 days. An unusual incident report will be submitted to CCL regarding the Incident In question which they became ware of on or around OB/14/14. Unusual Incident Report will be submitted no later than 09/26/14. SHe Director indicates will be submitting a written appaal wUhin 10 days. 7 Failure to correct the cited deficlency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Hilda Estrella TELEPHONE: (323) 981-2956 UCENSING EVALUATOR SIGNATURE: ~ DATE: 09/19/2014 1acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: I LICBOa (FAS) ~ (06/04) DATE: 09/19/2014 Psga: 2of2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 09/19/2014 1. Were regulatory violations issued during this visit? [gj Yes 0 2. If regulatory violations were cited, would they pose an immediate risk to the heaHh and safety of children in care, if not corrected (Type A)? 0 [gj No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) [gj Yes Yes 0 No No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Hilda Estrella Contact Person Telephone Number: (323) 981-2956 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC1!213 (FAS) • (1104) STATE OF CAUFORNIA- HEALTil AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NONCOMPLIANCE CONFERENCE SUMMARY· PAGE2 CCLD Regional Office, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK. CA 91754 NAME AND ADDRESS OF FACILITY: ST. ANNE'S EARLY LEARNING CENTER 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 FACILITY LICENSE NUMBER: EFFECTIVE DATE OF LICENSE: 198011690 07/15/2005 LICENSE CAPACrTY: STATUS: FACILrTY TYPE: 3 90 850 LICENSEE NAME(S): ST. ANNE'S MATERNITY HOME This Noncompliance Conference was called to discuss the following Issues or deficiencies: 1 1) Care and Supervision: 2 • 8/27/2013 A child was left unattended on 7/31/2013 resulting in the child wandering off 3 • 1/24/2013 A child had a piece of macaroni stuck up her nose and staff did not know how It happened. 4 o 5/17/2012 A child undressed self and ran aboutthe classroom A child routinely bit attacked staff either by biting, hitting, or kicking. Child also threw blocks and 5 o 5/2012 6 threatened other children in care. 7 o 10/03/2011 A child was left unsupervised for 2-5 minutes 8 o 9/05/2011 A child was left behind in the play yard. Staff did notice until after a minute of being in the 9 classroom . 10 • August 2011 A child was observed by a parent in the play yard by himself. Staff did not know until parent 11 alerted them. 12 • On or about 7/07/2010 A child fell off a piece of play equipment after using it inappropriately and broke arm 13 • 12/03/2009 Infants and preschoolers were commingled in the classroom 14 15 2) Reporting requirements: 16 o The 7/31/2014 incident of a child wandering off was not reported 17 • The CM visit on 6/25/2012 cited Licensee for failing to report a 5/21/2012 in which a child was threatening 18 staff and peers. 19 • 12/03/2009 Failure to report that facilitY had sustained water damage requiring shutting down facility for 20 rep8iis and relocating infants without notifying the Dept. 21 22 3) Physical Plant issues in terms of maintaining cleanliness and keeping facility In good repair--12/03/2009 water 23 damage when facilitY was flooded. 24 25 4) Ensuring all staff that start work in the facility are fingerprint cleared--cited on 9/03/2010 26 27 28 29 30 31 32 LICENSEE SIGNATU~.E DATE: 08/08/2014 MANAGER SIGNATURE: DATE: 08/08/2014 LIC9111 (FAS) • ~2/99) ·(PUBLIC) Pago: 2of4 STATE OFCALJFORNIA-HEALTH AND HUMAN SERVICES AGENCY CAUFORNlA DEPARTMENT OF SOCIAL. SERVICES COMMUNrTY CARE LICENSING OMSION NONCOMPLIANCE CONFERENCE SUMMARY CCLD Reg!Ohlll Om~. 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 NAME AND ADDRESS OF FACILITY: ST. ANNE'S EARLY LEARNING CENTER 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 FACILITY LICENSE NUMBER: EFFECTIVE DATE OF LICENSE: 198011690 LICENSE CAPACITY: 07/15/2005 STATUS: FACILITY TYPE: 3 90 850 LICENSEE NAME(S). ST. ANNE'S MATERNITY HOME NAME AND FACILITY NUMBER OF OTHER COMMUNITY CARE, CHILD DAY CARE, RESIDENTIAL CARE FACILITIES FOR THE ELDERLY, OR HEALTH FACILITIES LICENSED TO OR OWNED BY APPLICANT(S) WITrliN THE LAST FIVE YEARS. FACILITY NAME FACILITY NUMBER A. St. Anne's Early Learning Center 198011689 B. c. D. E. F. DATE OF CONFERENCE: 08/08/2014 LICENSING PROGRAM ANALYST: EAnn LICENSING PROGRAM MANAGER: Duma~ Present at meeting: NAME TonvWalker Sharon Spira-Cushnir Laura Hernandez Marla Hernandez Claudia Guahgorena Ann Dumolt L1C11111 {FAS)- (12/911)- {PUBUC) TITLE CEO coo S~e Director Regional Manager Licensing Program Manager Licensing Program Analyst Page: 1 of4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING OMSION NONCOMPLIANCE CONFERENCE SUMMARYPAGE3 CCLD Regional Offlco, 1000 CORPORATE CNTR DR. 20G-B MONTEREY PARK, CA 91754 NAME AND ADDRESS OF FACILITY: ST. ANNE'S EARLY LEARNING CENTER 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 FACILI1Y LICENSE NUMBER: EFFECTIVE DATE OF LICENSE: 198011690 07/15/2005 LICENSE CAPACilY: STATUS: FACILITY 1YPE: 3 90 850 LICENSEE NAME(S): ST. ANNE'S MATERNITY HOME Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates: 1 Licensee agrees to complete the following: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27. 28 29 30 With guidance from Head Start, care and supervision being addressed as follows: • Teachers being responsible for an assigned primary group. Each group has a primary and a secondary teacher so there is continuity of care especially with teachers going on break. Licensee is putting into practice "zoning," i.e., play yard is divided into zones. Each teacher stands in a particular zone and is responsible for monitoring children in the assigned zone. When children transition from outdoors to indoors and visa verse, one teacher leads the line and the other is at the end. There is count made to ensure that the number of children moving from one area to the other is the same number of children that arrives at the new area. Children are incorporated in helping teachers with the count, i.e., the children count off and will tell teachers if a child has not counted off. There is daily evaluation between the director and teachers to ensure what is working and what is not to ensure accountability of children's whereabouts especially as the new school year begins. • Change in attitude with staff: Licensee encouraged staff (with time and financial incentives) to earn B.A. in Early Child Development and to earn their teacher credential. Others have earned their A.A. in Early Child Development with earning assistant teacher credential. This has raised awareness in staff to be there for the children in care, i.e., it more than "just a job." • The Board of Directors now is incorporating members knowledgeable in Early Child Development and a Consumer Representative. This is helping parent needs to be heard, i.e, fosters transparency. There are monthly parent meetings that allow parents to voice concerns. • Additional funding has allowed for specialists to train staff and identification of a senior director knowledgeable in Early Child Development 31 32 LICENSEE SIGNATURE DATE: 08/08/2014 MANAGER SIGNATURE: DATE: 08/08/2014 UC9111 (FAS) • (12/99} ·(PUBLIC) Page: 3 or 4 STATE OF CALFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION NONCOMPLIANCE CONFERENCE SUMMARYPAGE4 CCW Regtonsl Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA91754 NAME AND ADDRESS OF FACILITY: ST. ANNE'S EARLY LEARNING CENTER 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 FACILITY LICENSE NUMBER: EFFECTIVE DATE OF LICENSE: 198011690 LICENSE CAPACITY: 07/15/2005 FACILITY TYPE: STATUS: 90 3 850 LICENSEE NAME(S): ST. ANNE'S MATERNITY HOME Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking the following action(s): 1 No administrative action will be taken at this time. Administration action process was explained. Facility will be 2 on required visits for the next four years effective this date. A copy of this Noncompliance is to be given to 3 parents or guardians of all children in care and to parents of newly enrolled children for the next full year. 4 Parents or guardians are to sign the LIC 9224, Acknowledgement of Receipt of Licensing Reports as proof of 5 receiving a copy ofthe Noncompliance Conference. A copy of the signed receipt is to be placed in the child's 6 file. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 0 A detailed letter regarding this conference will be mailed to the licensee within 5 calendar days. DAfE: LICENSEE SIGNATURE 08/08/2014 MANAGER SIGNATURE: DATE: 08/08/2014 • UC9111 (FAS)- (12/99)- (PUBLIC) Page:4of4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 EO'llUND G.SROWI-lJfl, GOVERNOR August 04, 2014 ST. ANNE'S EARLY LEARNING CENTER- 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Dear Sharon Spira-Cushnir and Laura Hernandez, Due to events occurring at your facility over the last several years, we have scheduled a Non-Compliance Conference on Tuesday, August 5, 2014 at 2:00 p.m. in the Monterey Park Regional Office at 1000 Corporate Center Dr., Suite #200-B, Monterey Park, CA 91754. The purpose of the conference is to discuss recent deficiencies, any problem areas in the operation of your facility, the seriousness of the situation, and the legal action which may be taken by the Department. If you wish, you may bring someone to help you in this review. It can be any person or persons of your choosing who may be of assistance to you. Also, if you are unable to keep this appointment, please contact Ann Dumolt, Licensing Program Analyst at (323) 981-3386, immediately so we may reschedule as soon as possible. Sincerely, MARIA HENDRIX Regional Manager C: File, Licensee ORIGINAL SIGNED BY SIGNATORY ''\f)j\ [ J_;•;, STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CDSS 1000 CORPORATE CNTR DR 200-B LI ; DEPARTMENT OF SOCIAL SERVICES MONTEREY PARK, CA 91754 Will IJGI!TBOURNE OiRECTOR EDMU!IP tl,;l!WWN JR GOVERt-KJR July 24, 2014 ST. ANNE'S EARLY LEARNING CENTER-198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Dear Laura Hernandez, Due to events occurring at your facility over the last several years we have scheduled a Non-Compliance Conference on Tuesday, August 5, 2014 at 2:00p.m. in the Monterey Park Regional Office at 1000 Corporate Center Dr., Suite #200-B, Monterey Park, CA 91754. The purpose of the conference is to discuss recent deficiencies, any problem areas in the operation of your facility, the seriousness of the situation, and the legal action which may be taken by the Department. If you wish, you may bring someone to help you in this review. It can be any person or persons of your choosing who may be of assistance to you. Also, if you are unable to keep this appointment, please contact Ann Dumolt, Licensing Program Analyst at (323) 981-3386, immediately so we may reschedule as soon as possible. Sincerely, . MARIA HENDRIX Regional Manager C: File, Licensee ORIGINAL SIGNED BY SIGNATORY STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAliFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNTTYCARE UCENSING DMSION FACILITY EVALUATION REPORT CCLO Regional OMca, 1000 CORPORATE CNTR OR. 200-8 MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CA CAPACITY: 90 CENSUS: 54 TYPE OF VISIT: Annual/Random UNANNOUNCED MET WITH: Desiree Guiterrez and Alberto Ramirez FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 05/06/2014 12:45 PM 03:30PM NARRATIVE (2) An unannounced Annual/Random visit was conducted on this date, by Stella Nersesyan, Licensing Program Analyst 1 (LPA). Met with Desiree Guiterrez, Assistant Director and Alberto Ramirez, Assistant Director, who guided LPA tour of the 2 facility. Wendy Castellanos, Director was at District meeting, and arrived shortly after. All areas identified on the Facility 3 Sketch (4) preschool classrooms, (1) yard, and rest-rooms were inspected and checked the following: 4 US clearances, staff/child ratio, children and staff records, food preparation area, storage and refrigeration, rest rooms, 5 equipment, outside play area and over all conditions of facility. Fumlture and equipment were inspected for age 6 appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's 7 belongings and an Isolation area with a sink, toilet was Inspected. Availability of drinking water was reviewed. Age 8 appropriate sinks and toilets were Inspected for availability, good repair, water temperatures, toilet paper, towels, area safety and sanitation. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, 190 and records was made. {Please contact your analyst for regulations If considering using Nebulizer or administering Blood-Glucose testing.) A notice of site visit was posted today and licensee was explained that It must remain posted for a 11 12 peliod or 30 days. Failure to keep poster posted will result in a $100.00 civil penalty. Fui:un~ to crb'ILJ:ln .a l';rimirm! rc-crmi bm:!;grct;r.d check c!r.:m•:;ncss p1lorto lnhir.;i pu?~,.''TiC0 wt !ho l'nci!ity will r;~,su!t in rm 13 lmm.xiia!e S 100.00 dolf,::r or m;)r,;: [:·Or (;l.sy Ch:il Pe-nnli.y. 14 Snack, lunch menus, food and snacks were reviewed for availability, quantity and appropriateness to children In care. Food 15 preparation areas were toured for safety, cleanliness and proper equipment. A review of cleaning and food supply storage 16 areas was made. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. 17 Required shade, drinking water and fencing were Inspected. Play area was inspected far hazards and Inaccessibility to 18 bodies of water. 19 Teacher child ratios were observed and staff names recorded. care and supervision was evaluated to determine ff the basic needs of children are met appropriately. Staff was questioned to establish their famiVarlty of emergency reporting 20 requirements, emergency disaster plans and other site operations. Sign in and out sheets and procedures were reviewed 21 with staff, policy of checking children for illnesses. Personal Rights of children were discussed and observed by LPA. 22 Children were Interviewed for general observations of facility operation. Staff and children records were reviewed for 23 completenesS including but not limited to Criminal Record Clearances for adults, Director Qualtfications and vertflcatlon of 241 CPR/Ffrst Aid and health preventive practices documentation. Inspection of required forms was made. 25 TELEPHONE: (323) 981-3365 SUPERVISOR'S NAME: Bertha Manzanares I LICENSING EVALUATOR NAME: Stella Nersesyan TELEPHONE: (323) 981-3350 LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2014 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACIUTY REPRESENTATIVE SIGNATURE: DATE: 05/06/2014 This report must be available at Child Care and Group Home faciiiHes for public review for 3 years. UCII0\1 (FAS)- (06/04) Page: 1 of3 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVJCES COMMUNilY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 20o-B MONTEREY PARK. CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: 198011690 VISIT DATE: 05/06/2014 NARRATIVE 1 2 3 4 5 6 7 8 9 The following deficiencies were observed or cited in accordance to Tit!e 22 of the California Code of Regulations and Health & Safety Codes on l!C8090. Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children In care at the facility and to parentsfguardians of children newly enrolled at the facility duting the next 12 months 1hat documents a Type A citation-this includes facility visits and substantiated complaint investigations. 10 11 12 13 14 15 16 17 18 19 20 21 Licensee will provide copies of Licensing report, and obtain signed LIC9224 for each child's file, when or above Is cited. WEB SITE ADDRESS is rwww ccld.ca.govl. Issued handbook on Child Abuse Reporting, Never Shake a Baby, end SIDS. Recent regulatory changes were discussed (including AB 633-Parent Notification and AS 2865~Healthy Schools Act Pesticide Use Requirements), AB 978 Zero Tolerance deficiencies. Exit interview was conducted Including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Stella Nersesyan TELEPHONE: (323) 981 -3350 LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2014 my appeal rights as FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2014 LICilOO (FAS) • (08/041 Page: 2 of3 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVK:ES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrTV CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Raglonal Office, 1000 CORPORATE CNTR DR.20D-B MONTEREY PARK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: 198011690 VISIT DATE: 05/06/2014 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number DEFICIENCIES TypeB 05/06/2014 Section Cited 101239 (n) 1 2 3 4 5 6 7 Type B 05/06/2014 Section Cited 101218.1(c) 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) 1 Assistant Director stated they have placed an order Furniture and equipment shall be in good condition, 2 with Lakeshore and they are in process of 3 replacing. free of sharp, loose, or pointed parts. Fixtures, Furniture, Equipment and Supplies. During tour of the outdoor yard, LPA observed (1) yellow tricycle missing rubber handles. 4 Assistant Director removed tricycle from playing 5 area until further repair Is done. 6 7 Admission Procedures- Parents Rights. The 1 Assistant Director stated she will obtain PUB393 2 from Department's Web Site and post in publicly 3 aocessible place. 4 5 6 7 licensee shall post the Child Care Center Notification of Parents' Rights poster (PUB 393[8/02]) In a publicly accessible place at all times. LPA did not observe Parents Rights poster PUB393 posted. 8 LPA did not observe poster posted In publicly 9 accessible place. 10 11 12 13 14 8 9 10 11 12 13 14 1 1 2 3 4 5 6 7 2 3 4 5 6 7 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: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Stella Nersesyan TELEPHONE: (323) 981-3350 LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2014 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2014 LICII()l; (FASJ· (06104) Page: 3 o13 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 05/06/2014 1. Were regulatory violations issued during this visit? !XI Yes r::J No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? D Yes lXI No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a reoordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) !XI Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Stella Nersesyan Contact Person Telephone Number: (323) 981-3350 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 {FAS} ~ (1104) . STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 EtlMUNDG. BROWil JR. ;;'"~ 1/ERNOr~ October 28, 2013 ST. ANNE'S EARLY LEARNING CENTER-198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 I have not been able to clear your deficiencies cited on 8/27/13 as I have not received a meeting agenda with topics and who gave the training and date. Also, the unusual incident report you completed needs to be revised as the information you provided is different from information obtained during staff interviews where it was clearly stated that no staff visually observed the wandering child leaving the playground into the preschool classroom. At this time, I cannot accept the corrections you sent. I have discussed this with my supervisor Christina Gabelman, and she is requesting the above information before your deficiencies can be cleared. If you should have any questions, please call me directly at 323-981-3366; You may also contact Licensing Program Manager Christina Gabelman at 323-981-3395. Sincerely, Grace Gonzalez Licensing Program Analyst [J] - STATE OF CALIFORNIA- HEALTH AND HUMAN SERVlCES AGENCY DEPARTMENT OF SOCIAL SERVICES CDSS VIllL llGHTBOURNE 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 ('Jir:tfCWJi~ EPMUNO (!,CROWN JR GOVERNOR October 07, 2013 ST. ANNE'S EARLY LEARNING CENTER-198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Dear Laura Hernandez, This letter acknowledges receipt of your appeal received in our office on September 9, 2013 regarding the site visits conducted on July 31, 2013 and August 27, 2013. Please note you will anticipate some delay before receiving a response to this appeal. Community Care Licensing Division (CCLD) has been prioritizing its workload in order to cover the most critical mandates. As a result, CCLD has reassessed its workload priorities in order to ensure the most significant health and safety issues are addressed. Appeals will continue to be accepted, however, they will be processed as resources permit. Please visit our website to access Department priorities at: www.ccld .ca.gov/res/pdf/CCLpriorities.pdf. If you have any questions regarding this process, please feel free to contact our office at 323) 981-3351. Sincerely, Christina Gabelman Licensing Program Manager Child Care-EAST Paga: 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOClAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Raglonal Omca,1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS:72 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: La~ra Hernandez, Sije Director 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 08/27/2013 09:15AM 01:00PM NARRATIVE Licensing Program Analyst (LPA), Grace Gonzalez conducted a Case Management visit to follow up on a wandering child from the playground Into the preschool classrooms wijh no visual observation .. This is an unusual incident of a wandering child that took place on 7/31/13, and to date it has not been reported to Licensing Office. Upon arrival LPA met with interim assistant director Nubia Cruz to inform of visit as site director Laura Hernandez was on sHe.l. Wandering child incident apparently took place on 7/31/13, and the child in question was from preschool room 112. A new teacher from preschool #4 while attending to another preschool child in the restroom saw the child in question In the preschool classroom by the door to the hallway standing wijh his mother. Teacher of preschool#2 later noticed the child had wandered away, but none of the staff In the playground area visually observed the child leave the playground into the preschool classrooms. LPA interviewed the teacher from preschool #4 and parent of the child. Today I am obtaining parent information of child in question, and confidential names list of some of the preschool children, taking pictures of the playground where staff stand during outdoor play and where the child was found wandering. Will measure area from restroom where preschool teacher #4 was to where the child was found standing next to his mother near the hallway door. Based on interviews conducted and information gathered, LPA is able to determined that the incident involving a child wandered away wijh no visual observation did occur. The preschool teacher that saw the wandering child did informed the assistant director of the incident. The facility to date has not reported . incident to Licensing and no Unusual incident report has been received regarding a wandering child. The incident of a wandering child Is a Zero Tolerance Violation and warrants an immediate civil penalty of $150.00. See deficiencies being cited in accordance to Tille 22 of the California Code of Regulations and Health & Safety Codes on this date. Exit interview was conducted wijh Laura Hernandez, Director, appeal rights and procedures explained. SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: J!;M ~ DATE: 08/27/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC909 (FAS) • (06/04) Page: 1 of2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERvtCE$ COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT (Cont) CCLD Regional otnoo, 1000 CORPORATE CNTR DR. 20G-B MONTEREY PARK, CA 91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: 198011690 VISIT DATE: 08/27/2013 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number Type A 08/28/2013 Section Cited 101229(a)(1) Type A 08/28/2013 Section Cited 101212(d) DEFICIENCIES Zero Tolerance- Absence of Supervision 1 2 A child left unattended, and lack of supervision 3 resulting in a child wandering away. No visual 4 observation. This Is an immediate civil penalty of 5 $150 will be assessed. 6 7 1 Reporting Requirements. 2 3 A report shall be made to the Department within 4 24 hours of the occurrence of any unusual incident 5 as specified. 6 7 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) Site Director Laura Hernandez will: Have weekly all 1 staff meeting and will be addressed In the agenda. 2 Ail staff will sign attending meeting and copy will be 3 provided to Ucenslng by 8/30/13 .. 4 5 6 7 1 Sne Director Laura Hernandez will: Will complete 2 the written unusual incident report and FAX by 3 B/28/13. 4 5 6 7 1 2 3 4 5 8 7 , , 2 3 4 2 3 4 5 5 6 6 7 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: /::J. DATE: 08/27/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2013 This Notice must be posted for 30 days UCBOO (FAS)- (06/04) Page: 2of2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 08/27/2013 1. Were regulatory violations issued during this visit? [gj Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A}? [gj Yes D 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.} [gj Yes D No No ONlY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Grace Gonzalez Contact Person Telephone Number: (323) 981-3366 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 {FAS)- (1/04) STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING OMS ION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR OR. 200-B MONTEREY PARK, CA 91754 This is an official report of an unannounced visiUinvestigation of a complaint received in our office on 08/07/2013 and conducted by Evaluator Grace Gonzalez COMPLAINT CONTROL NUMBER: 33-CC-201308071 03810 PUBLIC FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. LOS ANGELES STATE: CITY: CAPACITY: 90 CENSUS: 72 UNANNOUNCED MET WITH: Laura Hernandez, Site Director FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 08/27/2013 01:43PM 02:00PM ALLEGATION(S): 1 Physical Plant: Uncovered screws protruding in children's restroom 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst (LPA) Grace Gonzalez, conducted an unannounced site visit to conduct and 2 complete complaint allegation investigation. 3 4 Met with Laura Hernandez, Director, for the purpose to discuss the above allegation of Physical Plant. One 5 toilet is not flushing correctly and several toilets have protruding screws uncovered. 6 7 8 9 Besed on interviews conducted and personal observation complaint allegation is found to be Substantiated. Exit Interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 10 11 12 13 Substantiated SUPERVISOR'S NAME: Christina Gabelman Estimated Days of Completion: TELEPHONE: (323) 981-3395 UCENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 UCENSING EVALUATOR SIGNATURE: ~- DATE: 08/27/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 08/27/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC9039 (FAS)- {06/04) Paga: 2 of 3 Control Number 33-CC-20130807103810 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSlON COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 2QO-B MONTEREY PARK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type PDC Due Date I Section Number Type B 09/05/2013 Sectlon Cited 101238(8) FACILITY NUMBER: 198011690 VISIT DATE: 08/27/2013 DEFICIENCIES 1 2 3 4 5 6 7 Buildings and Grounds. The child care center shall be clean, safe, sanitruy and In good repair at all times. LPA observed one toilet not flushing correctly and needs repair. Several toilets have uncovered protruding screws. This Is a potential risk to the children in care. PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 Site Director will: Toilet needs to be repaired for proper flushing. Covers need to be Installed on all toilets with protruding screws. The new toilet will be replaced by B/28/13 and the covers for screws arrive on 8/30/13. 1 2 3 1 2 3 4 5 6 7 4 5 6 7 1 1 2 3 4 5 2 3 4 5 6 ' 6 7 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: M. J DATE: 08/27/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~ LIC8019 (FAS)· (06104) DATE: 08/27/2013 Page: 3 ora NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 08/06/2013 1. Were regulatory violations issued during this visit? 0 Yes ~ No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 0 Yes ~ No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes ~ No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Grace Gonzalez Contact Person Telephone Number: (323) 981-3366 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC92.13 {FAS) ~ (t/04) NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 07/22/2013 1. Were regulatory violations issued during this visit? D Yes ~ No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? D Yes ~ No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) D Yes ~ No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Grace Gonzalez Contact Person Telephone Number: (323) 981-3366 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9:<:13 (FAS)- (1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION COMPLAINT INVESTIGATION REPORT CCLD Regional otnce, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK, CA 91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/1 0/2013 and conducted by Evaluator Grace Gonzalez PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20130710101431 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: 72 MET WITH: Site Director Laura Hernandez FACIUTY NUMBER: FACIUTY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 08/27/2013 03:00PM 03:45PM ALLEGATION(S): 1 Personal Rights 2 Food Service 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst (LPA) Grace Gonzalez, conducted an unannounced site visit to conduct and 2 complete complaint allegation investigation. 3 4 Met with Laura Hernandez, Director, for the purpose to discuss the above allegations. 5 6 Based on interviews conducted and personal observation complaint allegations is found to be Substantiated. 7 Exit interview was conducted wlth Laura Hernandez, Directcr, appeal rights and procedures explained. 8 9 10 11 12 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez ~"~ro~X TELEPHONE: (323) 981-3366 DATE: 08/27/2013 I acknowledge receipt of this form and understand my appeal righta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS)- (08/04) Page: 1 of 2 Control Number 33-CC-2013071 01 01431 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSJQN COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-8 MONTEREY PARK, CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Duo Date I Section Number DEFICIENCIES 1 2 3 4 5 6 Type A OB/28/2013 Section Cited 101223(a)(2) 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment. All nap sheets that 1 Site Director will make sure all nap 'sheets that 2 cover cots are washed with detergent for proper 3 disinfecting. Corrected. cover cots must be washed properly for 4 5 6 disinfecting. 7 TypeS 08/28/2013 Section Cited 101223(a)(2) FACIUTY NUMBER: 198011690 VISIT DATE: 08/27/2013 7 Personal Rights. Each child shall be accorded safe, healthful and comfortable accommodations, furnishings and ~qulpment. Children will be provided with proper eating utenslis. LPA observed children were still being provided with plastic utensils from the kitchen play area. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 Site Director will make sure all children have proper 2 eating utensils during all meals. Corrected. 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deficlency(ies), on or before the Plan of Correction (POC) due date, may result In a cMI penalty assessment. SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 UCENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: ){) DATE: 08/27/2013 • I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2013 This Notice must be posted for 30 days UC9009 (FASI- (06/04) Page: 2 Df2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION COMPLAINT INVESTIGATION REPORT CCLD Reglonld Office, 1000 CORPORATE CNTR DR. 2QO-B MONTEREY PARK. CA91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/29/2013 and conducted by Evaluator Grace Gonzalez COMPLAINT CONTROL NUMBER: 33-CC-20130729133337 FACILITY NAME: ST. ANNE'S EARLYLEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CENSUS: 72 CAPACITY: 90 MET WITH: Laura Hernandez, S~e Director FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 08/27/2013 02:19PM 03:00PM ALLEGATION(S): 1 Other: The dividers between the four preschool classrooms are being moved and children are running around 2 all classrooms. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Licensing Program Analyst (LPA) Grace Gonzalez, conducted an unannounced site visit to conduct and 2 complete complaint allegation investigation. 3 4 5 Met with Laura Hernandez, Director, for the purpose to discuss the above allegation. 6 7 Based on interviews conducted and personal observation complaint allegation is found to be Inconclusive. Exit interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 8 9 10 11 12 13 Inconclusive Estimated Days of Completion: SUPERVISOR'S NAME: Christina Gabel man TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSIN/jLU~TOtJ..:~:...U..: ..'_ _ _ _(!III~rt. DATE: 08/27/2013 I acknowledge receipt of this form and understand my appeal righta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~ DATE: 08/27/2013 This report must be available at Child Care and Group Home facilities lor public review lor 3 years. UC9C!Q9 (FAS)- (06/04) Page: 1 of 1 STATE OF CALIFORNIA~ HEALTH AND HUMAN SEFMCES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 20G-B' MONTEREY PARK, CA 91764 This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/29/2013 and conducted by Evaluator Grace Gonzalez CONFIDENTIAL COMPLAINT CONTROL NUMBER: 33-CC-20130729133337 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: 55 UNANNOUNCED MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 361-2931 90026 08/06/2013 02:00PM 03:45PM ALLEGATION($): 1 Other: The dividers between the four preschool classrooms are being moved and children are running around 2 all classrooms. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Grace Gonzalez, Licensing Program Analyst (LPA), conducted an unannounced site visitor the purpose of a , 2 ten day visit due today to the facility regarding the above noted complaint allegations for investigation. 3 4 5 6 Met with Desiree Gutierrez, Assistant Director, to convey the above allegation and to in1orm that this is a visit that will only be to take the census count which was 55 preschool children, and a walk through of the facility for Preschool. 7 8 Based on the feet that there is not enough time for LPA Gonzalez to interview steff and review files today, the 9 findings for this visit is Needs Further Investigation. 10 11 Exit interview was c.onducted with Desiree Gutierrez, Assistant DireCtor, appeal rights and procedures 12 explained. 13 Estimated Days of Completion: Needs Further Investigation SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: I DATE: 08/06/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 08/06/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. L.IC9o99 (FAS) • (06104) Page: 1 or 2 STATE OF CALIFORNIA. HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Regional Omce, 1000 CORPORATE CNTR DR. 200..8 MONTEREY PARK. CA91764 This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/10/2013 and conducted by Evaluator Grace Gonzalez PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-2013071 0101431 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: 25 UNANNOUNCED Desiree Gutierrez, Assistant Director MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 07/22/2013 04:45PM 05:45PM ALLEGATION($): 1 Personal Rights 2 Food Service 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Grace Gonzalez, Licensing Program Analyst (LPA), conducted an unannounced sne visnor the purpose of a 2 ten day visn due today to the facility regarding the above noted complaint allegations for Investigation. 3 4 Met with Desiree Gutierrez, Assistant Director, to convey the above allegations and to inform that this is a visit 5 that will only be to take the census count which was 25 preschool ch~dren, and a walk through of the facilny for 6 Preschool. 7 8 Based on the fact that there is not enough time for LPA Gonzalez to interview staff and review fi_les today, the 9 findings for this visit is Nee~s Further Investigation. 10 11 Exit interview was conducted with Desiree Gutierrez, Assistant Director, appeal rights and procedures 12 explained. 13 Needs Further Investigation Estimated Days of Completion: SUPERVISOR'S NAME: Christina Gabelman TELEPHONE: {323) 981-3395 LICENSING EVALUATOR NAME: Grace Gonzalez TELEPHONE: (323) 981-3366 LICENSING EVALUATOR SIGNATURE: .h. DATE: 07/22/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATNE SIGNATURE: DATE: 07/22/2013 This report must be available at Child Care and Group Home facUlties for public review for 3 years. UC9099 {FAS) ~ {06104) Paga: 1 of 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional otnce, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE:CA 90 CAPACITY: CENSUS:40 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Laura Hernandez 1 2 3 4 5 6 7 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 196011690 850 (213) 361-2931 90026 04/15/2013 12:30 PM 02:30PM NARRATIVE Alanda Ricks, Licensing Program Analyst (LPA), conducted Case Management-Incident Visit to follow up on incident report personal rights alleging that a Teacher grabbed and pulled a child by the armpits. Incident Report LIC624 was received by the Department on 04/08/2013 via fax. Incident took place on April 05,2013. Met with Laura Hernandez, Director for the purpose vis~ was explained. During this visit LPA interviewed staff involved with incident. 8 9 10 Based on interviews conducted with staff Involved and video footage, II was determined that the incident involving child being grabbed and pulled by the armpits was deemed unfounded. 11 12 13 14 15 16 No deficjency Is bejng cited In accordance to Title 22 of the Ca!jfomla Code of Regulations and Health & Safety Codes on this date. ~ interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 17 18 19 20 I ~I SUPERVISOR'S NAME: Victor BauUsta TELEPHONE: (323) 981-3380 LICENSING EVALUATOR NAME: Alanda Ricks TELEPHONE: (323)961-3382 UC"'""" ,,_WA,OR "~ DATE: 04/15/2013 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. DATE: 04/15/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC600 (FAS)- (06/04) Page: 1 of 1 STATE OF CALIFORNIA.~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional OHJoe. 1000 CORPORATE CNm DR. 200-B MONTEREY PARK. CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: ADDRESS: 151 N. OCCIDENTAL BLVD. TELEPHONE: CITY: LOS ANGELES STATE:CA ZIP CODE: CAPACITY: 90 CENSUS:40 DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: Case Management MET WITH: Laura Hernandez TIME COMPLETED: 1 2 198011690 850 (213) 381-2931 90026 03/25/2013 09:30AM 11:30 AM NARRATIVE Alanda Ricks, Licensing Program Analyst (LPA), conducted case Management-lncldentVisitto follow up on incident report. 3 4 5 6 7 Incident Report LIC624 was received by the Department on March 20, 2013 via fax. Incident took place on March 19, 2013. Met with Laura Hernandez, Director, whom purpose of the visit was explained. During this visit LPA interviewed staff involved with incident. 8 9 10 11 12 13 14 15 Based on interviews conducted with staff involved it was determined that the incident involving children coming to school with nits and dirty which teacher report incident to Child Abuse Hotline, reporting neglect that was cioss reference to licensing. According to Laura Hernandez, director the children were excluded from the facility. Director also conveyed there are dally health checks of all children and no other children were infected with head lice, and the health department was also contacted and provided facility with resources for the families. The facility follow proper procedures and no deficiency is being cited at this time. 17 on this date on 161 No deficiency ls being cited in accordance to Title 22 of the California Code of Regulatjons and Health & Safety Codes uqao9D. 181 19 20 Exit interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 21 22 23! 24 25 SUPERVISOR'S NAME: Victor Bautista TELEPHONE: (323) 981·3380 LICENSING EVALUATOR NAME: Alanda Ricks TELEPHONE: (323)981-3382 LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2013 I acknowledge receipt of this form and understand my licensing appeal rlghta as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2013 This report must be available at "Child Care and Group Home facilities for public review for 3 years. L!C009 (FAS) - (06/04} Page: 1 of1 STATE OF CAUFORNlA wHEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLO ReglonaJ Omce,1000 CORPORATE CNTR DR. 20QwB MONTEREY PARK, CA91754 This is an official report of an unannounced visit/investigation of a complaint received In our office on 03/19/2013 and conducted by Evaluator Alanda Ricks PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20130319145225 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS:40 MET WITH: Laura Hernandez FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 03/25/2013 03:00PM 05:30PM ALLEGATION(S): 1 19: Other: facility does not have disinfected solutions and soap to wash sheets and utensils. 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Alanda Ricks, Licensing Program Analyst (LPA), conducted an unannounced site visit to conduct and complete 2 complaint allegation investigation. 3 Met with Laura Hernandez, Director, for the purpose to discuss the above allegation of facility not having 4 disinfected solution, soap to wash sheets and fork/spoons. 5 6 7 8 Based on interviews conducted of director, staff and personal observation complaint allegation is found to be inconclusive. 9 Exit interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 10 11 12 13 Estimated Days of Completion: Inconclusive TELEPHONE: {323) 981-3380 SUPERVISOR'S NAME: Victor Bautista LICENSING EVALUATOR NAME: Alanda Ricks TELEPHONE: (323)981-3382 LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2013 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 03/25/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. L1C9099 (FAS) (06/04) w Page: 1 of 2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 03/14/2013 1. Were regulatory violations issued during this visit? [:gj Yes D 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? D [:gj No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) [:gj Yes Yes D No No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Ana Chico Contact Person Telephone Number: (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9Z13(FAS) ·(1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Reglortal Offlc&, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 This is an official report of an unannounced visit/investigation of a complaint received in our office on 03105/2013 and conducted by Evaluator Ana Chico COMPLAINT CONTROL NUMBER: 33-CC-20130305104047 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CENSUS: 41 CAPACITY: 90 MET WITH: Carolina Valdo FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 {213) 381-2931 90026 03/14/2013 09:15AM 11:00 AM I ALLEGATION{$): 1 OTHER: Cups not available for children to drink water 2 OTHER: Admission Procedures and Parental and Authorized Representative's Rights 3 4j 51 61 . 71 8 9 INVESTIGATION FINDINGS: 1 Ana Chico and Teresa Ucon, Licensing Program Analyst {LPAs) conducted an unannounced complaint visit 2· relative to the above. LPAs met with Carolina Valdovinos , Assistant Director, who provided a tour of the 3 facility. 4 5 Upon arrival, LPAs observed cups missing in 3 of the four preschool classrooms. Per Assistant Director cups 6 have been ordered and should arrive shortly. Also, St Anne's Parent Handbook hours state that hours of 7 operation are 7:00 a.m - 5:30 p.m. Per Mrs. Valdovinos , at times there has been a shortage in staff which has 8 resuUed in asking parents to wait until sufficient staff is available. Assistant Director states that they will be 9 conducting Interviews to ensure that staff is always available to continue to maintain hours of operation as 10 stated in St. Anne's Parent Handbook. 11 12 Exit interview conducted with Assistant Director. Appeal rights provided and explained. This report and Notice 13 of Site Visit must be osted for 30 da Estimated Days of Completion: Substantiated TELEPHONE: {323) 981-3365 SUPERVISOR'S NAME: Bertha Manzanares LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: {323) 8966848 LICENSING EVALUATOR SIGNATURE: -At)h DATE: 03/14/2013 I acknowledge rl!celpt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC9099 (FAS) • (06104) Page: 1 of2 Control Number 33-CC-20130305104047 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAUFOANIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Offlco, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Typo POC Due Dale I Section Number TypeS 03/21/2013 Soction Cited 101218.1 TypeS 03/16/2013 Section Cited 101239(a) FACILITY NUMBER: 198011690 VISIT DATE: 03/14/2013 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 Interviews are being conducted. Enough staff Ylill 1 2 3 4 5 6 7 Admission Procedures and Parental and Authorized Representative's Rights: In accordance with the child care center's Individual program, policies and needs, the licensee shall develop, implement and maintain an admission procedure that enables the person In charge of admissions to:'IQetermlne 3 7:00a.m 4 5 6 7 8 9 10 11 12 13 14 that the child meets the child care center's admission criteria. Provides the chlld's parent or authorized representative with Information about the child care center that shall at least include the child care center's admission policies and procedures, activities, services, regulations, hours and days of operation ... 1' 8 9 10 11 12 13 14 1 2 3 4 5 6 7 Drinking Water: Uncontaminated drinking water shall be readily available both Indoors and out. 1 Cups have been ordered. Cups will be purchased 2 on this date. 3 4 5 Although water jugs were observed In (3) classes, no cups were available for children to drink out of. 2 be present to ensure that parent's can drop off at 6 7 1 1 2 3 4 5 6 7 2 3 4 5 6 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Bertha Manzanares TELEPHONE: (323) 981-3365 LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 LICJ::~~SI~'G EVALUATOR SIGNATURE: DATE: 03/14/2013 and as explained and FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2013 LJCli099 (FAS) • (06/04) Page:2ot2 STAT!: OF CAUFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT CCLD Regional otfk;e, 1000 CORPORATE CNTR DR. 200-8 MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS:36 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Laura Hernandez 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 01/24/2013 12:30 PM 02:20PM NARRATIVE Alanda Ricks, Licensing Program Analyst (LPA), conducted Case Management-Incident Visit to follow up on incident report. I Incident Report LIC624 was received by the Department on December 21, 2012 via fax. Incident took place on 12/19/2012. Met with Laura Hernandez, Director, whom purpose of the visit was explained. During this visit LPA interviewed staff involved with incident, and subject child was napping. LPA was unable to interview. Based on interviews conducted with staff involved it was determined that there was lack of visual supervision at the time of the Incident, hence none of the staff members present at the time observed how the incident happened. Notice of Site VIsit form must be posted for 30 days along with the Type A citation report. Licensee shall also give copy of Type A citation report to all parents of children currenUy enrolled and parents on newly enrolled children for the next 12 months. Licensee shall also have all parents sign LIC 9224 Acknowledgement Receipt of Licensing Report. The signed LIC 9224 shall be placed in child's file. 201 21 1 Exit interview was conducted with Laura Hernandez, Director, appeal rights and procedures explained. 22 23 24 25 SUPERVISOR'S NAME: Victor Bautista TELEPHONE: (323) 981-3380 TELEPHONE: (323)981-3382 DATE: 01/24/2013 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: )I DATE: 01/24/2013 This report must be available at Child Care and Group Home facilities for public review for 3 years. ucsos: (fAS)- (06104) Page: 1 ot2 STATE OF CAUFORNIA.- HEALTH AND HUMAN SERV1CES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CAAE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 2QO-B MONTEREY PAAK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Dellclency Type POC Duo Date/ Section Number DEFICIENCIES Type A 01/25/2013 Section Cited 101229 (a)(1) CARE AND SUPERVISION: 1 No chlld(ren) shall be left without supervision, 2 including visual obseJVation, of a teacher at any 3 time except es specified in sections 101216.2(e)(1) 4 and 101230(c)(1). 5 On 12/19/2012 subject #1 had a macaroni stuck In 6 her nose and staff did not know how It happened. 7 Based on Interviews conducted with staff involved i was determined that staff present at the time of tile incident did net see how it happened. 1 2 3 4 5 6 FACILITY NUMBER: 198011690 VISIT DATE: 01/24/2013 PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 Per Laura Hernandez, director stated she will conduct all staff training on visual supervision when working wHh children by POC date 02/1/2013 and submH a staff sign In sheet of all stall who attended training. 7 1 2 3 4 5 7 6 7 1 2 3 1 2 3 4 4 5 6 5 6 7 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Victor Bautista TELEPHONE: (323) 981-3380 LICENSING EVALUATOR NAME: Alanda Ricks TELEPHONE: (323)981-3382 LI(Ji;XJIGNAT~ DATE: 01/24/2013 I acknowledge receipt of this form and understand my appeal righta as explained and received. FACIUTY REPRESENTATNE SIGNATURE: DATE: 01/24/2013 This Notice must be posted for 30 days LICSOP (FAS) ~ (06104) Psga: 2 ot2 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 06/25/2012 1. Were regulatory violations issued during this visit? lXI Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? lXI Yes D ·No 3. If regulatory violations were cited, could they become a risk to the heatlh, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) lXI Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323)854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS) ~ (1104) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALFORNIA DEPARTMENT OF SOClAL SERVICES COMMUNIT'f. CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional Omce, 1000 CORPORATE CNm DR. 2~ MONTEREY PARK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE: CA CAPACITY: 90 CENSUS: TYPE OF VISIT: Case Management UNANNOUNCED MET WITH: Desiree Guitierrez, Carolina Valdovinos& Laura Hernandez 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: 198011690 850 (213} 381-2931 90026 06/25/2012 08:30AM TIME COMPLETED: 01:15PM NARRATIVE A case management visit was made this date relative to an Incident thattook place on 5·17-12. Child number 1 was able to take their clothes off and run around naked. Child #1 also made threats to other children in care. It appears that child number 1 has had several behavioral issues, mainly in the month of May. There have been several other incidents going back to November of 2011. Based on a review of the schools parent handbook, it does not appear that the school was following their own procedures. They did not have a shadow as indicated nor were services requested in a timely manner based on the child's behavior. It was known at the time of enrollment of behavioral issues. There was also an incident that occurred on the 21st of May were another threat was made that was not reported. The facility does not appear to have been able to provide proper care to child number one nor were they able to insure the heaHh and safety of the other children in care or their staff. Upon receipt the facility shall post the notice of site visit and licensing report. The notice of site visit and licensing report shall be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children in care by 21 1 the next business day or immediately upcn return. A copy of this report shall also be provided to the 221 parent/guardian of any newly enrolled child forthe next 12 months. 231 24 Exit interview conducted, Appeal rights explained and provided. 25 TELEPHONE: (323} 981-3381 SUPERVISOR'S NAME: Knute Martin 201 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323}854·7636 LICENSING EVALUATOR SIGNATURE: f\ DATE: 06/25/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. uc'"" (FAll) • (06/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTE REV PARK, CA 91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 198011690 VISIT DATE: 06/25/2012 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Type A 06/25/2012 Section Cited 101229(a) 1 2 3 4 5 6 7 The licensee shall provide care ar:d supervision as necessary to meet the children's needs. It does not appear that the facility was able to provide the care and supervision needed for child #1. On 5·17.12 the child was able to remove their clothing and run around as observed by a parent. 1 As of 6·29· 12 child is no longer enrolled In the 2 program 3 4 5 6 7 Type A 06/25/2012 Section Cited 101229(a) 1 2 3 4 5 6 7 The licensee shall provide care and supervision as necessary to meet the children's needs. On several occasions, almost daily for the month of May, and several occasions In earlier months. Child #1 was able to attack the staff by either biting, hitting & kicking. Child #1 also on several 1 As of 6·29-12 child is no longer enrolled in the 2 program 3 4 5 6 7 8 occasion's threw blocks and threatened the other 9 children in the class room. 10 11 12 13 14 Type A 06/25/2012 Section Cited 101212(d) 1 Any unusual Incident or child absence that 2 threatens the physical or emotional health or safety 3 of any child. On 5-21·12 child child #1 made the 4 same threat as on 5·17·12, this incident was not 5 reproted as required. 6 CIVIL PENALlY ACCESSED. REPEAT 7 VIOLATION 8 9 10 11 12 13 14 1 Will have additional training with staff on 2 completing all incidents reports and reporting to 3 staff. 4 5 6 7 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: Knute Martin TELEPHONE: (323) 981-3381 UCENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854·7636 LICENSING EVALUATOR SIGNATURE: ~~Sr7{/~ DATE: 06/25/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2012 This Notice must be posted for 30 days LIC80g (FAS) • (06/04) Pago: 2 of4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Raglonal Oftlce,1000 CORPORATE CNTR DR. 2QO-B MONTEREY PARK, CA91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Typo POC Duo Date I Section Number FACILITY NUMBER: 198011690 VISIT DATE: 06/25/2012 DEFICIENCIES PLAN OF CORRECTIONS(POCs) The licensee shall provide care and supervision as 1 At time of enrollment, will see if services are necessary to meet the children's needs. At the time 2 already being provlded,lf they are see that the 3 services are followed. If no services are being, of enrollment for child #1 , there is no evidence of anything being put into place to meet the needs of 4 assit obtaining required services. Type A 06/26/2012 Section Cited 1D1229(a) 1 2 3 4 5 6 7 Type A 06/25/2012 Section Cited 101223(a) 1 To be accorded safe, healthful and comfortable 2 accommodations, furnishings and equipment to 3 meet his/her needs. The facility was not insuring 4 that the other children present were afforded a safe 5 enviorment when they failed to meet the needs of 6 child #1. 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 the child as required, therefore the facility was unable to meet the needs of this child 5 6 7 That the Issues get addressed in the begining, that all staff are aware of the issues. Be in communication with staff. Tenninate services of child If unable to meet needs. Failure to correct the cited deficlency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~··-r~t/D DATE: 06/25/2012 I acknowledge receipt of this form and understsnd my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2012 This Notice must be posted for 30 days uceoo (FAS) ~ (06104) Page: 3of4 STATE OF CALFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Offtc., 1000 CORPORATE CNTR DR. 20G-B MONTEREY PARK. CA 917&4 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Defl.clency Type POC Due Date I Section Number TypeB Type B 06/26/2012 Section Cited 101173(a,b) FACILITY NUMBER: 198011690 VISIT DATE: 06/25/2012 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 1 c 2 3 4 5 6 7 2 3 4 5 6 7 1 During the review of the facility's parent handbook, 2 it was detennlned that the faciliiy did not follow 3 their own procedures relative to child Ill. There Is 4 no evidence of a shadow, 5 6 7 I When requesting services for TBS workem, will 2 have on going documentation from a tully qualified 3 pemon. 4 5 6 7 1 2 3 1 2 3 4 4 5 6 5 6 7 7. 1 1 2 3 4 5 6 7 2 3 4 5 6 7 Failure to correct the cited dellclency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers LICENSING EVALUATOR SIGNATURE: d50u~ TELEPHONE: (323)854-7636 \ DATE: 06/25/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 06/25/2012 LIC80S (FAS). (DS/04) P1g1: 4 of4 STATE OF CALIFORNIA- HEALTH ANC HUMAN SEI'MCES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVlCES COMMUNITY CARE UCENSIHG DMSION COMPLAINT INVESTIGATION REPORT CCLD Regional Offleo, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/17/2012 and conducted by Evaluator Karen Chambers · PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20120417121711 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: 50 UNANNOUNCED MET WITH: Claudia Garcia FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 04/27/2012 08:15AM 10:40 AM ALLEGATION(S): 1 Physical Plant • Cock Roaches 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 A complete walk through was made this date and there was evidence of roach motels in the class rooms. The 2 facility has also admitted that there has been an issue with roaches at times. 3 4 5 6 7 8 9 10 11 12 13 The above allegation is substantiated at this time. Upon receipt the notice of site visit and licensing report shall be posted and posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall be provided to the parent/guardian of children by the next business day or immediatiy upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled child next 12 months. NAME: Knute Martin LICENSING EVALUATOR NAME: Karen Chambers 981-3381 TELEPHONE: (323)854·7636 LICENSING EVALUATOR SIGNATURE: +~~~ DATE: 04/27/2012 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: <__,R~ DATE: 04/27/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC909; (FAS) • (06/04) Page: 1 Of 2 Control Number 33-CC-20120417121711 STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Otnce, 1000 CORPORATE CNTR DR.200.8 COMMUNITY CARE LICENSING DMSION MONTEREY PARK, CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type A 04/30/2012 Section Cited 101238(a) FACILITY NUMBER: 198011690 VISIT DATE: 04/27/2012 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 During this visit there was evidence of roaches, 2 there were motels observed and the facility stated 3 that there has been an issue of roaches. 4 5 6 7 1 2 3 1 Will provide proof of scheduled work order for 2 5-12-12. Will also provide a copy of future 3 maintenance plan. 4 5 6 7 1 2 3 4 4 5 5 6 7 6 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 1 1 2 3 4 5 6 2 3 4 5 6 7 7 Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~/J01LocA.O '""""'"Ji""""' '"""''""" DATE: 04/27/2012 1acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 04/27/2012 This Notice must be posted for 30 days LIC~ (FAS) - (06104) PagG: 2 Of2 All POC Have Been Cleared STATE OF CAUFORNIA • HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSlON CLEARED DEFICIENCIES CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACIUTY NUMBER: 198011690 VISIT DATE: 04/27/2012 POC Due Date I Date Cleared I Comments PLAN OF CORRECTIONS(POCs) Section Number 04/30/2012 101238(a) 1 2 ~ 5 6 7 Section Cited 1 2 3 4 5 B Will provide proof of scheduled work order for 5·12-12. Will also provide a copy of future maintenance plan. 1 04/27/2012 2 Proof of work order reo'd along with proof 3 of maintenance plan 4 1 2 3 4 7 1 Section Cited 2 3 4 5 6 7 Section Cited 1 2 3 4 5 6 7 1 2 3 4 1 2 3 4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL. SERVICES COMMUNITY CARE LICENSING OMS ION CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 04/30/2012 ST. ANNE'S EARLY LEARNING CENTER 1980.11690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 04/27/2012, have been cleared: Section Cited: 10123B(a) Date Due: 04/30/2012 Plan of Correction: Will provide proof of scheduled work order for 5-12-12. Will also Corrections: Proof of work order rec'd along with provide a copy of future maintenance plan. proof of maintenance plan UCENSING EVALUATOR NAME: Karen Chambers Clearance Date: 04/27/2012 TELEPHONE: (323)854-7636 LI~;UATOR SIGNATURE: -:>i~-;tca>vvr{9CA__,') DATE: 04/30/2012 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Letter (FAS)- (04/05) Page: 1 of 1 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 04/12/2012 1. Were regulatory violations issued during this visit? 0 Yes [gJ No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 0 Yes 0 No 3. If regulatory violations were cited, could they become a risk to the heatth, safety, or personal rights of children in care if not corrected {Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes 0 No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or notthis child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323)854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9210 (FAS}- (1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR OR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CENSUS: CAPACITY: 90 UNANNOUNCED TYPE OF VISIT: Case Management- Incident MET WITH: Jessica Makin 1 2 3 4 5 6, 7 8 9 10 11 12 13 14 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213} 381-2931 90026 04/12/2012 11:00 AM 01:30PM NARRATIVE A case management visit was made this date for the purpose of following up on several incident reports for 2-10,2-17-3-16 & 3-21-2012. During this visij documents were obtained and an additional review as well as additional documentation is needed. The facility has been reminded to Include the names of all parties involved, even if they were not the injured or victim. Upon receipt the notice of site visit shall be posted and posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.0 civil penalty. Exit interview conducted. 151 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323} 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323}854-7636 ~~ DATE: 04/12/2012 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2012 This report must be available at Child Care and Group Home facilities tor public review for 3 years. LICBo9 (FAS)- (06104) Page: 1 af1 STATE OF CALIFORNIA-'HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrTV CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Regf01111 OffiCe, 1000 CORpORATE CNTR DR. 200-8 MONTEREY PARK, CA817!4 This is an official report of an unannounced visit/investigation of a complaint received in our office on 10/17/2011 and conducted by Evaluator Karen Chambers PUBUC COMPLAINT CONTROL NUMBER: 33-CC-20111017150117 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: 13 MET WITH: Michelle Benitez & Jessica Makin FACIUTY NUMBER: FACIUTY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (21!3) 381-2931 90026 10/24/2011 08:35AM !0:25AM ALLEGATION(S): 1 Child wandered away 2 3 Reporting 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Approx. 2 weeks ago there was an incident were a child wandered out of the bathroom into another classroom 2 the teacher was not aware of this until the teacher in the class where the child wandered to, brought the child to 3 the teacher. 4 5 6 7 This incident was not reported as required, since the child was stili in a class that it did not need to be reported. Also staff are required to report any incident of child abuse to management who then in return will report to the proper authorities. This is not in accordance with the requirements of the Law. B 9 The above allegations are found to be substantiated at this time. 10 11 Upon reciept the Licensee/Site Director shall post the notice of site visit, for 30 consecutive days. Failure to 12 maintain posting as required w111 result in a $100.00 civil penally. 13 Estimated Days of Completion: Subatentlated TELEPHONE: (323) 981-3381 SUPERVISOR'S NAME: Knute Martin LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 UCENSING EVALUATOR SIGNATURE: DATE: 10/24/2011 FACIUTY REPRESENTATIVE SIGNATURE: DATE: 10/24/2011 This report must be available st Child Care and Group Home facilities for public review for 3 years. LIC90t9 (FAS)- (06/04) Pag•: 1 of 2 Control Number 33-CC-20111017150117 STATE OF CALIFORNIA.- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLO Regional Offico, 1000 CORPORATE CNTR OR. 200-B MONTEREY PARK, CA91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Dale I FACILITY NUMBER: 198011690 VISIT DATE: 10/24/2011 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number TypeB 10/24/2011 Section Cited 101229(a)1 1 2 3 4 5 6 7 No chlld(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. Approx 2 weeks ago a child wandered from the bathroom to another classroom without the knowledge of the teacher 1 2 3 4 5 6 7 In this particular case the staff person has been term Inated. Starting this week, staff are bsing retrained on policy & percedure, ongoing for the next 4 weeks. 8 It was not until the other staff perscn brought the 10 11 12 13 14 8 9 supervising the child, did they realize the child was 10 11 missing 12 13 14 1 2 3 4 5 6 7 Upon the occurrence, during the operation of the child care center of any of the events specffied in (d)(1) below, a report shall bs made to the Department by telephone or fax within the Department1S next working day and during its normal business hours. There was an incident were a child wandered Into another class room 9 child to the teacher who was to have been TypeS 10/24/2011 Section Cited 101212(d) 8 9 10 11 12 unknown by the teacher who was supervising. but never reported to the Dept as required, Also this agency is not following proper protocol when reporting child abuse. These reports are to be made by the person who suspects or has 1~ knowledge, they are to report to licensing and/or 14 the police, or child abuse hotline. 1 Will report immediately, completing unusual 2 Incident report. 3 4 5 6 7 8 9 10 11 12 13 14 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: Knute Martin TELEPHONE: {323) 9B1-33B1 UCENSING EVALUATOR NAME: Karen Chambers TELEPHONE: {323)654-7636 :;gj~19uo DATE: 10/24/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~1-~;ttrt.~ LIC9099 (1' ASj- (00104) DATE: 10/24/2011 Pags: 2 of2 NOTICE OF SITE VISIT BY A CHilD CARE liCENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 10/04/2011 1. Were regulatory violations issued during this visit? 12":1 Yes 0 No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 12":1 Yes 0 No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes 12":1 No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323}854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 (FAS)- (1/04) STATE OF CALIFORNIA~ HEALTH AND HU~ SERVICES AGENCY FACILITY EVALUATION REPORT CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PAFIK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: 151 N. OCCIDENTAL BLVD. ADDRESS: TELEPHONE: CITY: LOS ANGELES STATE:CA ZIP CODE: CAPACITY: 90 CENSUS: DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: Case Management MET WITH: Laura Hernandez TIME COMPLETED: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 198011690 850 (213) 381-2931 90026 10/04/2011 08:50AM 12:55 PM NARRATIVE During the course of a case managment visit made relative to an incident that occured on 10-3-11 it was determined that a child's whereabouts were not known for approx 5 mins. Based on interviews conducted it was determined that a child was left outside unsupervised. The transistion time from the outside to the inside for 16 children (washing hands) was 5 to 6 mins. During this time the missing child was told to get back in line once. It was when the other class went outside to play that the child was noticed outside. Upon receipt the Notice of site visit and licensing report shall be posted and posted for 30 consecutive days. Failure to maintain posting as required will resu~ in a $100.00 civil penalty. A copy of this report shall also be provided to the parenVguardian of children in care and to the parenVguardian of any newly enrolled child for the next 12 months. Exit Interview conducted and appeal rights explained and provided. 241 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2011 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY RE~RESrAv SIGNATUR: C/~f\~- DATE: 10/04/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS) • {06:'04) Page: 1 or2 STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOClAL SERVICES COMMUNITY CARE LICENSING OMSION. FACILITY EVALUATION REPORT (Cont) CCLD Regional Offlce, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Doflclency Type POC Duo Date I Section Number Type A 10/04/2011 Section Cited 101229(8)1 FACILITY NUMBER: 198011690 VISIT DATE: 10/04/2011 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 No chlld(ren) shall be left without tile supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. On 10-3-11 a child was left unsupervised for approximately 2 to 5 mins CIVIL PENALTY 1 2 3 4 5 6 7 1 2 3 4 1 Implementing transition form, which went Into effect 2 10-3-11. Training being provided all tllis week. 3 This form was provided after the incident took 4 place. 5 6 7 1 2 3 4 5 6 7 1 2 3 5 4 5 6 6 7 7 1 2 3 4 5 1 2 3 4 5 6 7 6 7 Failure to correct the cited deflclency(ies), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~-rtl9j~ DATE: 10/04/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ,~f/()~/ DATE: 10/04/2011 This Notice must be posted for 30 days UCBOD (FAS)- (06104) Page: 2 of2 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY FACILITY EVALUATION REPORT CALFORNlA DEPARTME!fT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION CCLD Regional OMct, 1000 CORPORATE CNTR DR.20C-B MONTEREY PARK. CA 117M FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS: UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Laura Hernandez 1 2 3 4 5 6 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 09/21/2011 08:45AM 03:40PM NARRATIVE A case management vlsn was made this date in reference to an incidentthat occured on 9-15-11'. During this visit ateff were interviewed, regarding this incident Based on the Incident report and Interviews, the facility Is being cited, for.faflure to provide proper care and supervision. Upon reciept the Licensee/Site Director shall post the notice of site visit, the licensing report as well as proof 7, of corrections for 30 consecutive days. Failure to maintain posting as required will resuH in a $100.00 civfl 8! penaity. A copy of this report shall be provided to the parent/guardian of children currently enrolled and to the 9 parent/guardian of any newly enrolled child for the next 12 months. 10 11 Exit Interview conducted and appeal rights explained and provided. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUP RVIS R'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854·7636 LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2011 I acknowledge receipt of this fonn and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years: LIC80> (FAS)- (06i04) Page: 1 of2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Dale/ Section Number Type A 09/21/2011 Section Cited 101229(1) DEFICIENCIES 1 2 3 4 5 6 PLAN OF CORRECTIONS(POCs) No child(ren) shall be left wnhout the supervision of 1 Transition head count form being emplimentad 2 along with a primary care group of children that a teacher at any time, except as specified in 3 they will be repsonsible for. Sections 101216.2(e)(1) and 101230(c)(1). 4 Supervision shall Include visual observation. On 5 9·15-11 a child was left outside. The child was 6 noticed to be missing 7 7 Type A 09/21/2011 Section Cited 101229(a)1 FACILITY NUMBER: 198011690 VISIT DATE: 09/21/2011 B 9 10 11 12 13 14 after the staff had came inside and a count was made. It appears that it may have been a minute or less before the child was observed to be missing. CIVIL PENALTY ACCESSED 8 9 10 11 12 13 14 1 2 3 4 5 6 7 In August (2011) there was a child that was observed outside in the yard by themself. It was not until a parent brought it to the attention of the staff that this was known. How ling child was outside alone is unknown CIVIL PENALTY ACCESSED 1 Transition head count form being emplimented 2 along with a primary care group of children that 3 they will be repsonsible for. 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited dellciency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 UCENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 UCENSING EVALUATOR SIGNATURE: ·k~/\ DATE: 09/21/2011 FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2011 This Notice must be posted for 30 days UCS09 (FAS) - (08/04) Page: 2 of2 STATE OF CAUFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSlON FACILITY EVALUATION REPORT CCLD Reglonal Office, 1000 CORPORATE CNTR DR. 2QO-B MONTEREY PARK, CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: ADDRESS: 151 N. OCCIDENTAL BLVD. TELEPHONE: CITY: LOS ANGELES ZIP CODE: STATE:CA CAPACITY: 90 DATE: CENSUS: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: POC MET WITH: Laura Hernandez TIME COMPLETED: 1 198011690 850 (213) 381-2931 90026 09/21/2011 08:45AM 03:40PM NARRATIVE A plan of correction visit was made this date to insure that the Hems cited during the 9-14-11 visit have been made and in accordance wHh THie 22, California Code of Regulations. 2 3 During this visit the following Items were observed to have been corrected: 4 5 SEE PROOF OF CORRECTIONS LETTERS. 6 7, 81 During this vlsH the following items are being recited as they have not bee corrected as required by the 9 scheduled due date. Civil Penalty's are also being issused for failure to correct. 10 11 I Upon reciept the Ucensee/Site Director shall post the notice of site visit, the licensing report as well as proof 12 of corrections tor 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil 13 penalty. A copy of this report shall be provided to the parenVguardian of children currently enrolled and to the 14 parenVguardian of any newly enrolled child for the next 12 months. 15 16 Exit interview conducted and appeal rights explained and provided. 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: :i'1J1/Yrl(9( //v·\ DATE: 09/21/2011 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. ucoo• (FAS)- (06/04) Page: 1 of3 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT (Cont) CCLD Regional Offfca, 1000 CORPORATE CNTR DR. 20CI-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ FACILITY NUMBER: 198011690 VISIT DATE: 09/21/2011 PLAN OF CORRECTIONS(POCs) DEFICIENCIES Section Number Type A 09/21/2011 Section Cited 101439{h)4 1 RECITED: The changing that is used to change 2 those that are being potty trained was observed to 1 Will increase boiler temp & investigate to see why 2 still low. 3 4 5 4 5 6 7 3 be near a sink that has water only at 90 degrees 6 7 Type A 09/21/2011 Section Cited 101239(e)1 1 RECITED: The sink in p/s1, the water was 2 observed to still be at 90 degrees. This sink is 3 used by the staff to wash their hands & to was their 4 toys 1 Will increase boller temp & investigate to see why 2 still low. 3 4 5 6 7 5 6 7 1 2 1 2 3 3 4 5 6 7 4 5 6 7 1 2 3 1 2 3 4 5 6 7 4 5 6 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~\ DATE: 09/21/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2011 This Notice must be posted for 30 days LICS09 (FAS) - (<16/04) Page:2o1'3 STATE. OF CAUFORHIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVJCES COMMUNTTY CARE LICENSING DMStoN FACILITY EVALUATION REPORT (Cont) CCLD Regional Omce, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK, CA91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number TypeS 09/2t/2011 Section Cited t012t2(d) TypeS 10/21/20t1 Section Cited 101215.1 (d)1 FACILITY NUMBER: 198011690 VISIT DATE: 09/21/2011 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 2 3 4 5 6 7 RECITED:Upon the occurrence, durtng 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. Last month there was a child that was observed by a parent In the yard 1 Will report all Incidents lmmediatly. & use log to 2 double check to insure that nothing has fallen 3 through the cracks. 4 5 6 7 8 unsupervised. It was nat until this parent brought it 9 to the attention of the staff that this was known. 10 This Incident was never reported as requlnsd. 11 12 13 14 8 9 10 11 12 13 14 1 2 3 4 5 6 7 t Will discuss at next fica! meeting. Will have the 2 group administrator to oversea this program. 3 4 5 6 7 The current site director also overseas and has dealing with the group home that is on site as well as the child care program for those residents. That child care program is not part of the licensed day·care program. By having to deal with this othe program(s)it Is causing the director to not be a full time functioning site 8 director as required for the licensed day.care 9 program, 10 11 12 13 14 8 9 10 11 12 13 14 Failure to correct the cited deflclency{les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) 981-3381 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~1'1/")/90~/~) DATE: 09/21/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACIUTY REPRESENTATIVE SIGNATURE: C}{;Q!/l1~ VN~/\/\_/\ LIC809 (FAS) - (06/04) DATE: 09/21/2011 Page: 3 of3 NOTICE OF SITE VISIT BY A CHILD CARE liCENSING OFFICE REPRESENTATIVE A s~e vis~ or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 09/21/2011 1. Were regulatory violations issued during this vis~? ~ Yes 0 No 2. If regulatory violations were ctted, would they pose an immediate risk to the heaHh and safety of children in care, if not corrected (Type A)? ~ Yes 0 No 3. If regulatory violations were ctted, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) ~ Yes 0 No ONlY VISIT REPORTS DOCUMENTING TYPE A VIOlATIONS AND CORRECTIONS OF VIOlATIONS MUST BE POSTED IN THE CHilD CARE FACiliTY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323)854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 {FAS)- (1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAliFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional Offlce, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS: 59 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Michelle Benetiz & Laura Hernandez 4 5~ 198011690 850 (213) 381-2931 90026 09/14/2011 08:30AM 02:20PM NARRATIVE A tour of the facility was made this date by Karen Chambers, LPA. This LPA was guided on a tour by the assistant director Michelle Benetiz. At the conclusion of !he tour !he site director arrived. 1 2 3 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: I During !he course of a case management visit made this date !he following items were observed and rare being cited in accordance with lltle 22, Callfcrnia Code of Regulations: sj 9! Upon receipt !he Notice of site visit and licensing report shall be posted and posted for 30 consecutive days. 10 I Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this report shall also be provided to !he parent/guardian of children in care and to the parent/guardian of any newly enrolled child for 11 12 the next 12 months. 13 14 Exit Interview conducted and appeal rights explained and provided. 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ) L9VVJ DATE: 09/14/2011 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~ DATE: 09/14/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. I.IC&l9 (FAS)- (Ofl/D4) Page: 1 of3 STATE. OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTA DFt 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number FACILITY NUMBER: 198011690 VISIT DATE: 09/14/2011 PLAN OF CORRECTIONS(POCs) DEFICIENCIES Type B 09/19/2011 Section Cited 101238(a) 1 The blue rug in the p/s 2-3 and the chairs were 2 observed to be dirty & in need of cleaning 3 4 5 6 7 1 Will pull rug to get cleaned and will clean the chairs 2 3 4 5 6 7 Type B 09/14/2011 Section Cited 101212(d) 1 2 3 4 5 6 7 1 Will report all incidents 2 3 4 5 6 7 8 9 10 11 12 13 14 TypeB 09/19/2011 Section Cited hs1596.8595(c)1 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 Depertment by telephone or fax within the Department's nexi workiilg day and during its normal business hours. There was a child that sustained a head injury and was taken to the hospital via ambulance. Til is incident was never reported as required. This incident is not noted in the child's file. Repeat violation, civil penalty accessed. An lmmdediate $150.00 plus $50.00 per day until corrected and verified. 1 The flies that were reviewed, there Is no evidence 2 of the parent/guardian having received copies of 3 licensing reports documenting type "A11 deficiency1s 4 5 6 7 8 9 10 11 12 13 14 1 Will place in children 1s files. 2 3 4 5 6 7 Failure to correct the cited deficiency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karan Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2011 DATE: 09/14/2011 L!Cl!OO (FAS) - (05/04) Page:2of3 CALFORNlA. DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 09/21/2011 ST. ANNE'S EARL_Y LEARNING CENTER 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Ucensee, The following deficiencies, initially cited during a visit on 09/14/2011, have been cleared: Section Cited: 101238(a) Dale Due: 09/19/2011 Plan of Correction: Corrections: Rugs were removed Will pull rug to get cleaned and will clean the chairs TELEPHONE: (323)854-7636 WCENSING EVALUATOR NAME: Karen Chambers WCENSr?EVrl:OR SIGNi~:: A~ /_~·V"Y"\~ Clearance Date: 09/21/2011 DATE: 09/21/2011 ) This report must be available at Child Care and Group Home facilities for public review for 3 years_ Cleare.t POC Letter (FAS) - (04/05) Page: 1 af 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: 198011690 VISIT DATE: 09/14/2011 DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Typo POC Due Date I Section Number Type A 09/14/2011 Section Cited 101439(h)4 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 The changing table that is used was observed to 2 not be within arms reach of hot water as required 3 4 5 6 1 Will open up the hot water 2 3 4 5 6 7 7 Type A 09/14/2011 Section Cited 101239(e)1 1 2 3 4 5 6 7 1 Will have maintenance look at The sink In p/s 1 that Is used for the washing of staff hands and the children's toys was observed to 2 3 have water that was only 90 degrees. This Is 15 4 degree's belOw the minimum requirement 5 6 7 Type A 09/14/2011 Section Cited 101227(A)1B 1 The refrigerator was observed to be dirty both 2 inside and out. 3 4 5 6 7 1 Will get house keeping to clean 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 Failure to correct the cited deliciency(ies), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~-0J{9Glv) DATE: 09/14/2011 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: /lA?~ DATE: 09/14/2011 This Notice must be posted for 30 days UC0011 (FAS)- (06/04) Page: 3 of3 CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNtTY CARE LICENSING DMSION STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 09/21/2011 ST. ANNE'S EARLY LEARNING CENTER 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, iniTially cited during a vistt on 09/14/2011, have been cleared: Section Cited: 101227(A)1B Date Due: 09/14/2011 Plan of Correction: Corrections: Clearance Date: WJI1 get house keeping to dea'1 The refrigerator was observed to be 09/21/2011 clean during this visit LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~vn&£AO DATE: 09/21/2011 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC Lefler (FAS) ~ (04105) Page: 1 of 1 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 09/14/2011 1. Were regulat<;>ry violations issued during this vistt? [gj Yes D No 2. If regulatory violations were ctted, would they pose an immediate risk to the health and safety of children in care, .if not corrected (Type A)? [gj Yes D No 3. If regulatory violations were ctted, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) [gj Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's stte visit report, you may view the report at the faciltty or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323)854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 tFAS} ~ (1/04) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OMS ION FACILITY EVALUATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 2QD-B. MONTEREY PARK. CA91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS:28 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Laura Hernandez 1 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 02/16/2011 !1:00AM 12:15 PM NARRATIVE This is an elee)ronic copy of a hand written report dated 2-16-11 2 3 4 5 6 7 8 9 10 11 12 13 A case management visit was made in reference to an incident report for 2-8-11. An attempt was made to interview child #1, but to no avail. Child #2 was not present. The facility has been advised to include the children involved in incidents when applicable in their investigation(lnterview process 14 15 16 17 18 19 20 21 22 23 24. 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 UCENSING EVALUATOR SIGNATURE: DATE: 02/16/2011 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACIUTY REPRESENTATIVE SIGNATURE: DATE: 02/16/2011 This report must be available at Child Care and Group Home facilities lor public review for 3 years. LICtiOO (FAS) • (06/04) Page: 1 of1 STATE OF CAll IOCR!~ lA. HEAlTH AND HUMAN SERVICES AGENCY CALIFORNIA OEPARTMENT OF SOCIAL SERVICES FACILITY VISIT SUMMARY REPORT Complaint Control Number: DEFICIENCY/CIVIL PENALTY INFORMATION u Type A LJ Civil Penalty Assessed I i Penalty Notice Given ~eB Deficiency Cited l I Penalty Cleared AREA OF DEFICIENCY(IES) D Limits of License D Criminal Record D Records D Food Serv~ D D D D Program/Operation Health Related/Medical Services Physical Plant Qualifications I ; Penalty Not Cleared I i Deficiencies Cleared ! ) Deficiencies Not Cleared D D D D Staffing/Ratio Care and Supervision Personal Rights Other ·e read and understand the electronic version of the full licensing report completed today at this facility. I acknowledge receipt of this form and understand my appeal rights as explained on the back of this form. If "A" violations are cited, child care providers .must post this report pending receipt of final report. 1 1 1 ·rn;,;:m;REPRESE I . TURE • ; - - - - · - - · - - - - - - - ------~- I WI I HEN PROVIDING A PRINTED COPY OF THE ELECTRONIC REPORT TO THE LICENSEE: I certify that the attached is a true and correct copy of the electronic field visit report completed at the facility on ______________~~.---------------(Oate) (LPA Signature) (Date) --LlC 809S (810-!) _____ __ _______ _ . , PAGE 1 OF 2 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORN:!A DEPARTMENT OF SOCIAl SERVJCES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Om co, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK. CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. LOS ANGELES STATE: CA CITY: CAPACITY: 90 CENSUS: 0 TYPE OF VISIT: Office ANNOUNCED MET WITH: laura Hernandez, Site Director & Jessica Makin, Sr. Director, Community Based Programs 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 · 25 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: 198011690 850 (213) 381-2931 90026 11/05/2010 !0:05AM TIME COMPLETED: 11:30 AM purpose 1 incidents that occurred on 8/26/2010 and 9/09/2010 in which the whereabouts of a child could accounted. In the first case, a child was unaccounted for about 25 minutes. Ms. Hernandez stated that surveillance cameras indicated that the child was accounted. Tape showed that child was in an area of the classroom that is somewhat hidden (due to a divider) but there was another teacher present In the classroom who could see the child. Classroom has been rearranged so that if the entire class vacates the room, there are no areas where a child may be hidden away and therefore missed. In the second case, teachers failed to communicate as children moved from onE! place to another. Ms. Hernandez met with staff to re-iterate the need to communicate and ensure chiildren are accounted for at all times. In both cases a staff was held accountable for failure to keep track of children in care and was terminated. Another staff was written up. All staff have been made aware that once a child is signed in, that child's whereabout must be accounted for at all times. There is ongoing weekly training and retraining to ensure staff understand their responsibly for care and supervision of children. Other items: Ensure all staff are fingerprint cleared and associated to facility. Ms. Hernandez stated that a pool of employees used as substitutes from Child Care Careers agency is kept These employees must check in with Director to ensure association of employees. Otherwise that it will appear that staffing is out of ratio. Staff to ensure appropriate use of play equipment and immediated assessment of an injured child, e.g., use of first aid in which a child is assessed for an This is in reference to a child who fell after off a 1 but it it was not broke LICENSING EVALUATOR NAME: EAnn Dumoit TELEPHONE: (323) 240-6201 LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2010 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LICBOO (FAS)- {06/04) Page: 1 or2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISK)N FACILITY EVALUATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CMTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: 198011690 VISIT DATE: 11/05/2010 NARRATIVE 1 2 3 Ms. Hernandez and Ms. Makin stated that will receive additional training from the Program for Infant and Toddler Care. This will take place later this month and contiue into early December. At this time, no referral for administrative action will be made. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 SUPERVISOR'S NAME: Knute Martin TELEPHO E: 323) 981-3350 LICENSING EVALUATOR NAME: EAnn DumoU TELEPHONE: (323) 240-6201 UCENSING EVALUATOR SIGNATURE: DATE: 11/05/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACiUTY REPRESENTATIVE SIGNATURE: DATE: 11/05/2010 LIC80> (FAll)· (06/04) Page: 2 01' 2 STAT:: CF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOClAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional otnce, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: ADDRESS: TELEPHONE: 151 N. OCCIDENTAL BLVD. ZIP CODE: CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS: DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: Case Management MET WITH: Carolina Valdovinos & Jessica Makin TIME COMPLETED: 1 2 3 4 5 6' 7 8 9 198011690 850 (213} 381-2931 90026 09/10/2010 08:50AM 10:00 AM NARRATIVE A case management visit was made this date relative to incidents that occurred on 8/26 & 9/9/10, where a child's whereabouts were not known. On 8/26/10 a child was in his class while the rest ofthe class was outside for aprox 25 mins. It was not until another teacher came on duty & another was going on break that the child was observed in the class-room. n On 9/9/10 a child was left behind In the class for approx 2 mins. The schools policy is that the children are counted before they go outside & before they come back inside. The facilitY will also do a head count, through the day. The above incidents did involve the same staff. At this time it is the recommendation of this LPA thatthe facility be called in for either an informal or noncompliance meeting, to discuss these issues. 10 A copy of this licensing report along with the notice of site visit must be posted for 30 consecutive days. 12 Failure to maintain posting as required will result in a $100.00 cMI penalty. A copy of this licensing report is 131 to be provided to the parents/guardians of all children currently enrolled, by the next business day or immediately upon return. A copy of this report is also to be given to the parent/guardians of any newly enrolled children for the next 12 months. 16 17 11 141 151 ~~I 20 21 ! 221 23 241 251 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323} -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323}854-7636 LICENSING EVALUATOR SIGNATURE: D-rMY\(91N) DATE: 09/10/2010 1 acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ;1 L;1·1.. 1 ( !l ..~ Ii u 1714/,_, v-- 'titiZ s t DATE: 09/10/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LICBO' (FAS) • (06/04) Page: 1 of2 STAT!:. OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office. 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK.CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deflclency Type POC Due Date/ FACILITY NUMBER: 198011690 VISIT DATE: 09/10/2010 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number Type A 09/14/2010 Section Cited 101152(c)3 E 1 On 2 separate occasion 8/26/10 & 9/9/1 o a child's 2 whereabouts were not known. On 1 occasion It 3 was for approx 25 mins the other 2 mins. Staff do 4 not appear to be following facility rules tor counting 5 children before leaving the class·room & before 6 entering. 7 4 5 6 7 1 2 1 2 3 4 3 1 Steff #1 was terminated effective 9/9/10. 2 Steff 112 will be receiving a final written notice. 3 4 5 5 6 6 7 7 1 2 1 2 3 4 5 6 3 4 5 6 7 7 1 2 3 4 5 1 2 3 4 5 6 6 7 7 Failure to correct the cited deflclency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~~Y\L91JV) DATE: 09/10/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: f\&s, "'/' ¢2G>z-'1--.. f._f"J/'(j> =-- I DATE: 09/10/2010 ~...../""' This Notice must be posted for 30 days LIC809 (FAS) • (06104) Peg•: 2 Df 2 NOTICE OF SITE VISIT BY A CHILD CARE liCENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 09/03/2010 1. Were regulatory violations issued during this visit? ~ Yes 0 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected {Type A)? ~ Yes 0 No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected {Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) ~ Yes 0 No No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Karen Chambers Contact Person Telephone Number: (323)854-7636 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS)- (1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVlCESAGENCY CALIFORNlA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Offlca, 1000 CORPORATE CNTR DR. 200..8 MONTEREY PARK, CA91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: ADDRESS: 151 N. OCCIDENTAL BLVD. TELEPHONE: CITY: LOS ANGELES STATE:CA ZIP CODE: CAPACITY: 90 CENSUS: DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: Case Management MET WITH: Laura Hernandez TIME COMPLETED: 1 2 198011690 850 (213) 381-2931 90026 09/03!2010 10:05AM 01:30PM NARRATIVE A case management visit was made this date, By Karen Chambers, LPA. During this visit the following was cited in accordance with Title 22, California Code of Regulations: 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A copy of this licensing report along with the notice of site visit must be posted for 30 consecutive days. Failure to maintain posting as required will result in a $100.00 civil penalty. A copy of this licensing report is to be provided to the parents/guardians of all children currently enrolled, by the next business day or immediately upon return. A copy of this report is also to be given to the parent/guardians of any newly enrolled children for the next 12 months. Exit interview conducted & appeal rights explained & provided. 22 23 24 25 SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: £ C!V\1 DATE: 09/03/2010 I acknowledge receipt of this form and understand my licensing appeal rights as explained and recaived. FACIUTY REPRESENTATIVE SIGNATURE: ;tt:~l;\6L/L/\.~ DATE: 09/03/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. UC809 (!'AS)· (06/04) Page: 1 Of4 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LiCENSING DMSION FACILITY EVALUATION REPORT (Cont) CCLD Regional Office. 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: FACILITY NUMBER: 198011690 VISIT DATE: 09/03/2010 Deficiency Type POC Due Date I PLAN OF CORRECTIONS(POCs) DEFICIENCIES Section Number TypeB 10/01/2010 Section Cited 101217(a) 1 Will insure that ali substitues have a completed file 1 During the review of the flies for staff #4, It was 2 determined that the files are Incomplete, there was 2 on the premises. 3 only a trustJine transfer request. 3 4 5 6 4 5 6 7 7 1 2 3 4 7 1 2 3 4 5 6 7 1 2 3 1 2 3 5 6 4 4 5 6 7 5 6 7 1 2 3 4 1 2 3 5 6 5 6 7 7 4 Failure to correct the cited deficlency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: u\&h.w-19{.~) DATE: 09/03/2010 I acknowledge receipt of this fonm and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 9JC61/~W4~/\_, UCB09 (FAS)- (06/04) DATE: 09/03/2010 Pago: 2of4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNnY CARE UCENSING DMSlON FACILITY EVALUATION REPORT (Cont) CCLD fleglonal Office, 1000 CORPORATE CNTR DR. 200.8 MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date/ Section Number FACILITY NUMBER: 198011690 VISIT DATE: 09/03/2010 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 f 2 3 4 5 6 7 TypeS 09/03/2010 Section Cited t01217(d)1 1 2 3 4 5 6 7 TypeS 09/24/2010 Section Cited 101217(8) 1 Durtng an attempt to review the files of staff #4, the 2 only thing In file was a trustllne transfer request. 3 No other documents. 4 5 6 7 1 f 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 At 11 :OOam files were requested for review all but one file was delivered the 3rd file was delivered until12:05pm. The files are kept at the HR dept that Is on the grounds but a dlfferant address, 1 2 3 4 5 6 7 6 7 1 2 3 4 5 6 7 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: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~ro·y+;t(v) DATE: 09/03/2010 I acknowledge receipt of this form and understsnd my appeal rights as explained and receivad. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2010 LICI!Oil (FAS) • (0&,1)4) Page: 3 o14 STATE OF CALIFORNIA· HEALTH AJ.ID HUMAN SEFMCES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrYCARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Reglonaf omce, 1000 CORPORATE CNTR DR. 2QO.B MONTEREYPARK.CAS11754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DERCIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number FACILITY NUMBER: 198011690 VISIT DATE: 09/03/2010 PLAN OF CORRECTIONS(POCs) DEFICIENCIES 1 Will create a pool of substitute staff to be pulled 2 from and have them associated prior to need. 3 4 Type A 09/03/2010 Section Cited 101170(e) 1 2 3 4 5 6 7 Type A 09/03/2010 Section Cited 101216.3(8) 1 On 7-7-10 there ware 17 children In the cere of 1 2 teacher. The facility was out of ratio by 5. 3 4 5 6 7 1 Based on the pool to be created, will have all of the 2 necessary forms/documents In place to Insure that 3 steff ere fully qualllled. 4 5 6 7 1 2 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 It was determined during this vlsU the Vernice Espinoza does not have the required clearance to be on the premises., After a check U was determined that Mz. Espinoza is ilot associated with any facility. 3 5 6 7 Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result ln. a civil penalty aasessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) ·98·3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2010 This Notice must be posted for 30 days LIC80II (FAS) • {Otlill4) Page: 4of4 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CAAE LICENSING DMSION COMPLAINT INVESTIGATION REPORT CCLD Regional Offlce, 1000 CORPORATE CNTR DR. 200-B MONTEFIEV PARK,CA91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 08124/2010 and conducted by Evaluator Karen Chambers PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20100824145727 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CAPACITY: 90 CENSUS: MET WITH: Laura Hernandez FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 09/03/2010 10:05AM 01:30PM ALLEGATION(S): 1 Neglect/Lack of Supervision 2 3 Reporting Requirements 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 There was an incident thattook place on 7-9-10 that was called into the dept; however there was no written 2 report submitted as required. 3 Failure to report as required is substantiated. 4 5 6 7 8 9 10 11 12 13 TELEPHONE: (323) LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: dCR~N~) DATE: 09/03/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2010 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9009 {FAS) ~ {06104) Pagu: 1 Of 3 Control Number 33-CC-20100824145727 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regloml Office, 1000 CORPORATE CNTR OR. 20Q..B MONTEREY PARK. CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Dalfclancy Type POC Due Date I Section Number Type A 09/03/2010 Section Cited 101152(c)3 E,F FACILITY NUMBER: 198011690 VISIT DATE: 09/03/2010 DEFICIENCIES 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) On the date In question (7-7-10) It appears that the 1 All of the staff were spoken to during a meeting 2 regarding correcting a child's behavior lmmedlatly, staff observed the child using an apperatlce Incorrectly and made no attempts to stop the child 3 and not waiting. from using the equipment incorreclly. The child wa 4 not sitting dawn correctly, thus losing their balance, 5 6 falling, & caused the child to sustain a fractured 7 arm. 8 It was not until the child feilthatthey were spoken 9 too about the proper use of the play equipment. 10 11 12 13 14 8 9 10 11 12 13 14 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 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: Knute Martin. TELEPHONE: (323) ·98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323}854-7636 LICENSING EVALUATOR SIGNATURE: db({y-vrY)/.9t!\Jr--.,'\ 1 DATE: 09/03/2010 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/201 0 This Notice must be posted for 30 days UC9099 (FAS) ~ (06/04) Page: 3o13 Control Number 33-CC-20100824145727 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION COMPLAINT INVESTIGATION REPORT (Cont) CCLD Regional Office, 1000 CORPORATE CNTR DR. 200·8 MONTEREY PARK, CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number TypeB 09/03/2010 Section Cited 101212(d)1,2 FACILITY NUMBER: 198011690 VISIT DATE: 09/03/2010 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 There was an incident that occurred on 7-7-10that was not reported to the dept via the phone, but a written report was received at 5:30pm the next day. There appears to be another incident that took placa on B-26-1 0 that was not reported until B-30-10. 1 2 3 4 5 6 7 B 9 10 11 12 13 14 The facility also failed to contact the parent/guardian when they were aware that the child was in distressed. The facility Is not following the requirements for reporting Incidents B 9 10 11 12 13 14 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 Stall have been notified that anytime a child is hurt no matter the severity, that the parent/guardian Is contacted immediatly and noted on the IR (incident report) Failure to correct the cited deficlency(ies), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Knute Martin TELEPHONE: (323) -98-3365 LICENSING EVALUATOR NAME: Karen Chambers TELEPHONE: (323)854-7636 LICENSING EVALUATOR SIGNATURE: ~~1() DATE: 09/03/2010 I acknowledge receipt of this fonn and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2010 UCOC09 (FAS) • (06/04) Page: 2 of3 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 12/17/2009 1. Were regulatory violations issued during this visit? 0 Yes i)g No 2. If regulatory violations were cited, would they pose an immediate risk to the hea~h and safety of children in care, if not corrected (Type A)? 0 Yes i)g No 3. If regulatory violations were cited, could they become a risk to the hea~h, safety, or personal rights of children in care if not corrected {Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes l2l No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Ana Chico Contact Person Telephone Number: (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 (FAS)- (1/04) STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE:CA 90 CAPACITY: CENSUS: 22 UNANNOUNCED TYPE OF VISIT: Case Management Michelle Benitez MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 12/17/2009 01:35PM 02:00PM NARRATIVE 1 A Case Management visit was conducted by Ana Chico, LPA. LPA met with Laura Hernadez, Center Director 2 for St. Anne's ELC, who provided LPA on a tour of the facility. The purpose of the visit is to Inspect all 3 classrooms as the pre-school rooms received major flood damage. LPA toured the classroom to ensure that 4 furniture and equipment are in working order. Rugs, ftoor and walls are observed to have been replaced, 5 cleaned and free of mold. 6 No deflcelncles were cited during this visit 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 TELEPHONE: (323) 981-3395 SUPERVISOR'S NAME: Joan Hayes LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 UCENSING EVALUATOR SIGNATURE: DATE: 12/17/2009 I acknowledge receipt of this form and understand my licensing appeal rlghte as explained and received. DATE: 12/1 7/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC009 (FAS) • (06/04) Page: 1 of 1 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 12/07/2009 1. Were regulatory violations issued during this visit? 0 Yes ~ No 2. If regulatory violations were cited, would they pose an immediate risk-to the heaHh and safety of children in care, if not corrected (Type A)? 0 Yes ~ No 3. If regulatory violations were cited, could they become a risk to the health,"safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes ~ No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Ana Chico Contact Person Telephone Number: (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS) " (1/04} STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAl. SERVICES COMMUNITY CARE LICENSING DMSJON FACILITY EVALUATION REPORT CCLD Regional Office, 1000 CORPORATE CNm DR. 2t!D-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACILITY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACILITY TYPE: ADDRESS: 151 N. OCCIDENTAL BLVD. TELEPHONE: CITY: LOS ANGELES STATE:CA ZIP CODE: CAPACITY: 90 CENSUS:O DATE: UNANNOUNCED TIME BEGAN: TYPE OF VISIT: POC MET WITH: Laura Hernandez TIME COMPLETED: 1 2 3 4 5 6 7 8 9 198011690 850 (213) 381-2931 90026 12/07/2009 11:05AM 12:00 PM NARRATIVIE A case management visit was conducted by Ana Chico, LPA. The purpose of !his visit is to follow up on a substantiated complaint filed with the Department. LPA rnet with Laura Hernandez, Director, who guided analyst on a tour of the areas perviously used for care. No children were observed in such areas. LPA also received LIC 624 Unusual Incident Report was submitted on this date. Director will submit updated emergency relocation site information. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 SUPERVISOR'S NAME: Joan Hayes TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2009 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~?Ul·~ DATE: 12/07/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC809 (FAS)o(06/04} Page: 1 of1 NOTICE OF SITE VISIT BY A CHilD CARE liCENSING OFFICE REPRESENTATIVE A site visit or complaint Investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 12/03/2009 1. Were regulatory violations issued during this visit? 181 Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 181 Yes D No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 181 Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA91754 Regional Office Contact Person: Ana Chico Contact Person Telephone Number: (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC!l213 (FAS)- (1/04) STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING; DMSION COMPLAINT INVESTIGATION REPORT CCI..D Rlgfonal Offlc:a, 1000 CORPORATE CNTR DR. 20G-B MONTEREY PARK. CA91754 This is an official report of an unannounced visitlinvestigation of a complaint received in our office on 11/30/2009 and conducted by Evaluator Ana Chico COMPLAINT CONTROL NUMBER: 33-CC-20091130170234 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER FACIUTY NUMBER: ADMINISTRATOR: LAURA HERNANDEZ FACIUTY TYPE: ADDRESS: 151 N. OCCIDENTAL BLVD. TELEPHONE: CITY: LOS ANGELES ZIP CODE: STATE: CAPACITY: 90 DATE: CENSUS: 16 UNANNOUNCED TIME VISIT BEGAN: Michelle Benitez MET WITH: TIME COMPLETED: 198011690 850 (213) 381·2931 90026 12/03/2009 01:15PM 03:00PM ALLEGATION(S): 1 Physical plant-Day care children were moved to unsanitary location 2 3 Reporting Requirements-facility relocated without notification 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 Ana Chico, LPA, conducted an unannounced complaint visit on this date pertaining to the above allegations. 2 LPA met with Michele Benitez, Assistant Director for the Infant Program and Laura Hernandez, Director, who 3 took analyst on a tour of the Community Room and Learning Lounge. Upon arrival, LPA observed 16 children 4 sleeping. Per staff, 2 of the children were preschool age and 14 were infants. Ages of children combined in 5 the Community Room range between 13 months to 4.5 years of age. Per Director resident's children were 6 being cared for in unlicensed area for three days. LPA received message on 11/30/09 from Laura Hernandez 7 indicating thatthe center would be closing as it had sustained water damage. The area where children were 8 relocate is not equipped for adequate care nor does it provide sanitary conditions of infants that are 9 commingled with preschool age children. 10 11 Based on LPA observations and interviews conducted, LPA has found this complaint to be substantiated. 12 13 Estimated Days of Completion: Substantiated TELEPHONE: (323) 981-3395 SUPERVISOR'S NAME: Joan Hayes LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACIUTY REPRESENTATIVE SIGNATURE: 7/:r~/ DATE: 12/03/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9009 (FAS}- (06/04) Page: 1 of 2 Control Number 33-CC-20091130170234 STATE OF CAUFORNIA* HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrrY CARE LICENSING OMS ION COMPLAINT INVESTIGATION REPORT (Cont) CCLO Regional Ofnce, 1000 CORPORATE CNTR 00.200-8 MONTEAEV PARK, CA91754 • FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Dale/ Section Number FACIUTY NUMBER: 198011690 VISIT DATE: 12/03/2009 DEFICIENCIES PLAN OF CORRECTIONS(POCs) 1 2 3 4 5 6 7 DISASTER AND MASS CASUALlY PLAN Type A 12/03/2009 Section Cited 101174(b) equipped to provide safe temporary accommodations for children. 1 Director stated that the center will close and reopen 2 in two weeks. 3 4 5 6 7 Type A 12/03/2009 Section Cited 101212 1 2 3 4 5 6 7 REPORTING REQUIREMENTS LPA received call from Director stating that the center would be closing as there was severe water damage. The Department was not notlfted that the children at the facility would instead be relocating 1 Director will submit an unusual incident report. The 2 center will be closed untll12/14/09 3 4 5 Type A 12/03/2009 Section Cited 101438.3 (b) Relocation site do to flooding of the center Is not to a different site. 6 7 1 2 3 4 5 6 7 Regulations "Indoor activity space for infants shall 4 be physically separate from space used by children 5 6 In the child care center... 11 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 INDOOR ACTIVIlY SPACE 1 Center will close untll12/14/09. Children between 13 months and 4. 5 years of age 2 3 were observed to be commingling. Per Title 22 Failure to correct the cited deficlency(les), on or before the Plan of Correction (POC) due date, may result In a civil penalty assessment. SUPERVISOR'S NAME: Joan Hayes TELEPHONE: {323) 981·3395 UCENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 UCENSING EVALUATOR SIGNATURE: DATE: 12/03/2009 I acknowledge receipt of this fonm and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~~6( DATE: 12/03/2009 This Notice must be posted for 30 days LIC9099 (FAS) ~ (06104) Page: 2 of2 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 12/07/2009 ST. ANNE'S EARLY LEARNING CENTER 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a vis~ on 12/03/2009, have been cleared: Section Cited: 101174(b) Date Due: 12/03/2009 Plan of Correction: Corrections: Clearance Date: Director stated that the center will close and reopen In two weeks. No children were observed 12/07/2009 Section Cited: 101212 Plan of Correction: Director will submtt an unusual incident report. The center will be closed untl112/14/09 Section Cited: 101438.3 (b) Plan of Correction: Center will close untll12114109. LICENSING EVALUATOR NAME: Ana Chico Date Due: 12/03/2009 Corrections: Clearance Date: Cleared By Visit LIC 624 was provided 12/07/2009 during visit Date Due: 12/03/2009 Corrections: Clearance Date: Cleared By Visit No children were observed 12/07/2009 TELEPHONE: (323) 8966848 LICENSING EVALUATOR SIGNATURE: .....____ l ~~~- DATE: 12/07/2009 ~·/ ~ This report must be available at Child Care and Group Home facilities for public review for 3 years. Cloared POC Letter (FAS}- (04/05) Page: 1 or 1 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 10/20/2009 1. Were regulatory violations issued during this visit? IZI Yes 0 No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 0 Yes IZI No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children In care if not corrected (Type B)? (Examples include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) 0 Yes IZI No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 Regional Office Contact Person: Ana Chico Contact Person Telephone Number: (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS} ~ (1/04) STATE OF CALFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION FACILITY EVALUATION REPORT CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK. CA 91764 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: LAURA HERNANDEZ ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE: CA CAPACITY: 90 CENSUS: 29 TYPE OF VISIT: POC UNANNOUNCED MET WITH: Laura Hernandez and Carolina Valdovinos 198011690 850 (213) 381-2931 90026 10/20/2009 11:18 AM 12:45 PM NARRATIVE A plan of correction vistl was conducted on this date by Ana Chico, LPA. Met wtlh Carolina Valdovinos, Assistant Director for the Pre-school Program and Laura Hernandez, Director, who guided Analyst on a tour of the faciltly. Children's records were reviewed during this visH 1 2 3 4 5 6 7 8 FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: SEE ATTACHED POC LETTER(S) 9j The following has been observed to be corrected as previously cited on 10/09/09 in accordance with Trtle 22, California Code of Regulations: I Sign in and out sheet was observed to be corrected 131 14 10 Jugs of water and cups were observed in all pre-school rooms 11 Yard was observed to be clean 12l T.B test was observed on file for Staff# 3 and # 4 15 16 17 18 19 20 21 22 23 24 25 See 809D for recited deficiency Upon receipt, Licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months that documents a Type A citation-this includes facility visits and substantiated complaint investigations. Exit interview was conducted with Carolina Valdovinos, Assistant Director for the Pre-school Program, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role. SUPERVISOR'S NAME: Joan Hayes TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 LICENSING EVALUATOR SIGNATURE: _./"} ~·\_;.- DATE: 10/20/2009 I acknowledge receipt of this fonm and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ~-;;4·t1l~ OATE: 10/20/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years•. LIC80li (FAS) • (08104) Page: 1 of2 STATE OF CAUFORNIA ~HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING OTV/SlON FACILITY EVALUATION REPORT (Cont) CCLO Regional OMce, 1000 CORPORATE CNTA DR. 200-B MONTEREY PARK, CA 91754 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: FACIUTY NUMBER: 198011690 VISIT DATE: 10/20/2009 Deficiency Type POC Due Date/ Section Number DEFICIENCIES TypeB 10/30/2009 Section Cited 101216 1 Specimen Result Certificate submiUed tor Staff# 3 2 and # 4 does not suffice the LIC503 Health 3 Screening Report requires for facility personnel. 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 1 2 3 4 5 6 7 PLAN OF CORRECTIONS(POCs) Director stated that she would inquire if there are any other forms that can be provided In addition to the result certificate on file. LPA provided a copy of the LIC503 during the visit. 3 4 5 6 7 Failure to correct the cited deflciency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment SUPERVISOR'S NAME: Joan Hayes TELEPHONE: (323) 981-3395 UCENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 UCENSING EVALUATOR SIGNATURE: ~"/. DATE: 10/20/2009 1acknowledge receipt of this form and understand my appeal rights as explained and received. DATE: 10/20/2009 liCOOil (FAS)- (06104) Page: 2 of2 STATE OF CALIFORNIA~ HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSION CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 11/03/2009 ST. ANNE'S EARLY LEARNING CENTER 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, initially cited during a visit on 10/20/2009, have been cleared: Secllon Cited: 101216 Plan of Correction: Date Due: 10/30/2009 Corrections: Director stated that she would Inquire if there are any other fonns that 503 submitted by fax can be provided in addmon to the result certificate on file. Clearance Date: 11/03/2009 LPA provided a copy of the LIC503 during the visit. LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cleared POC LeHer (FAS} ~ {04/05} Page: 1 Of 1 NOTICE OF SITE VISIT BY A CHilD CARE liCENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 10/09/2009 1. Were regulatory violations issued during this visit? ~ Yes 0 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? 0 Yes ~ No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected. (Type B)? (Examples include a record keeping violation that would impact the care of children or a violation that would impact those services required to meet children's .needs.) 0 Yes ~ No No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a copy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 · Regional Office Contact Person: Contact Person Telephone Number: Ana Chico (323) 8966848 THIS NOTICE MUST BE POSTED FOR 30 DAYS UC9213 (FAS) • (1~) STATi:1: OF CAUFORNIA ~HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT CCLD Regional Dfflca, 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91764 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: GUADALUPE GRIJALVA ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS:36 UNANNOUNCED TYPE OF VISIT: Annual/Random Carolina Valdovinos MET WITH: FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 10/09/2009 02:35PM 05:15PM NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 An unannounced Annual/Random visit was conducted on this date, by Ana Chico,LPA. Licensing representatives met with Carolian Valdovinos, Assistant Director, who guided analyst tour of the facility. All areas identified on the Facility Sketch were inspected and checked the following: LIS clearances, staff/child ratio, staff records, food preparation area, storage and refrigeration, equipment, outside play area and over all conditions of facility. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Storage for children's belongings and an isolation area with a sink, toilet was inspected. Availability of drinking water was reviewed. Age appropriate sinks and toilets were inspected for availability, good repair, water temperatures, towels, area safety and sanitation. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. (Please contact your analyst for regulations if considering using Nebulizer or administering Blood-Glucose testing.) A notice of site visit was posted today and licensee was explained that it must remain posted for a period or 3.0 days. Failure. to keep poster posted will result in a $100.00 civil penalty. 12 13 14 15 16 17 18 Snack, lunch menus, food and snacks were reviewed for availability, quantity and appropriateness 19 to children in care. Food preparation areas were toured for safety, cleanliness and proper 20 equipment. A review of cleaning and food supply storage areas was made. Outdoor equipment 21 was inspected for safety, cushioning material, good repair and age appropriateness. Required 22 shade, drinking water and fencing were inspected. Play area was inspected for hazards and 23 inaccessibility to bodies of water. 24 25 TELEPHONE: (323) 981-3395 SUPERVISOR'S NAME: Joan Hayes UCENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 DATE: 10/09/2009 1acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: c)~~~J·-~~ DATE: 10/09/2009 This report must be available at Child Care and Group Home faciiHies for public review for 3 years. UCB'§t •t:t UCBOP (FAS) ~ (06/04} d DATE: 10/09/2009 Page: 2of3 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT (Cont) CCLD Regional Offic.,1000 CORPORATE CNTR DR.200-B MONTEREY PARK, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Date I Section Number Type B 10/19/2009 Section Cited 101216 Type B 10/09/2009 Section Cited 101238(d)(2) TypeS 10/09/2009 Section Cited 101229.1 (a)(1) Type B 10/16/2009 Section Cltad 101239.2 (a) FACILITY NUMBER: 198011690 VISIT DATE: 10/09/2009 DEFICIENCIES 1 A review of staff flies found that teachers # 3 and # 2 4 flies missing health screening, TB, etc. 3 4 Required to maintain heaHh and safety of children 5 in care. PLAN OF CORRECTIONS(POCs) 1 Director stated that she would ensure that all staff 2 records are updated by POC date. 3 4 5 6 7 6 7 1 OUTDOOR ACTIVITY SPACE 2 3 LPA observed heavy debrl in preschool playground. 4 Outdoor equipment must be free of debri that can 1 Grounds were cleaned during visit 2 3 4 6 7 6 7 5 pose a health hazard to children in care. 1 2 3 4 SIGN IN AND SIGN OUT During the visit, LPA, observed that sign in and out sheet did not match the number of children present. One child was not signed In as child Is 5 1 2 3 4 Director stated that the sign In and out sheet will be corrected. In addition, teachers will be asked to remind parents to sign in and out when they drop off and pick up. 5 usually bussed in. 6 5 6 7 7 1 DRINKING WATER 2 3 During the visit LPA's did not observe drinking 4 water readily available In the preschool 'Toddler' 5 room. 6 Chlldr~n must have water easily accessible at all 7 times. 1 Director stated that she will have containers of 2 water and cups available for children to easily 3 access by POC date. 4 5 6 7 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: Joan Hayes TELEPHONE: (323) 981-3395 LICENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966648 LICENSING EVALUATOR SIGNATURE: ---,~,_;.__·-- DATE: 10/09/2009 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: /}_ /I ::::J_//' (;Jh?f/;- f v0(>6 6£ zC LIC809 (FAS) • {06/04) DATE: 10/09/2009 Page: 3 ot3 CAUFORNIA DEPARTMENT OF SOCIAL SERVICES STATE OF CAUFORtiiA • HEALnt AND HUMAN SERVICES AGENCY COMMUNrTY CARE LICENSING DMBION CCLD Regional Office 1000 CORPORATE CNTR DR. 200-B MONTEREY PARK, CA 91754 10/21/2009 ST. ANNE'S EARLY LEARNING CENTER 198011690 151 N. OCCIDENTAL BLVD. LOS ANGELES, CA 90026 Letter of Deficiency Citations Cleared Dear Licensee, The following deficiencies, inHially cited during a visH on 10/09/2009, have been cleared: Section Cited: 101216 Plan of Correction: Director stated that she would ensure that all staff records are Date Due: 10/19/2009 Corrections: Cleared By Vlstt Clearance Date: 10/2012009 updated by POC date. Saction Cited: 101238(d)(2) Plan of Corractfon: Grounds were cleaned during visit. Section Cited: 101229.1(&)(1) Plan of Corractfon: ·Director stated 1hat the sign In and out shoat will be corrected. In addftlon, teachn will be asked to remind parents to sign in and out when they drop off and pick up. Section Cited: 101239.2 (a) Plan of Corractfon: Dlrett:cr stated that she will have containers of water and cups Data Due: 10/09/2009 Corrections: Cleared By Vistt Clearance Date: Date Due: 10/09/2009 Corractfons: Cleared By Vistt Clearance Date: Date Due: 10/16/2009 Corractfons: Cleared By Vistt Clesrance Date: 10/20/2009 10/20/2009 10/20/2009 avalleble for children to easily access by POC date. UCENSING EVALUATOR NAME: Ana Chico TELEPHONE: (323) 8966848 UCENSING EVALUATOR SIGNATURE: ) DATE: 10/21/2009 This report must be available at Child Care and Group Home facilities for public review for 3 years. Cl•md POC latter (FAS) • (04105) Page: 1 ot 1 NOTICE OF SITE VISIT BY A CHILD CARE LICENSING OFFICE REPRESENTATIVE A site visit or complaint investigation was conducted at: ST. ANNE'S EARLY LEARNING CENTER 198011690 ON 06/13/2006 1. Were regulatory violations issued during this visit? [;8J Yes D No 2. If regulatory violations were cited, would they pose an immediate risk to the health and safety of children in care, if not corrected (Type A)? D [;8J No 3. If regulatory violations were cited, could they become a risk to the health, safety, or personal rights of children in care if not corrected (Type B)? (Examples Include a recordkeeping violation that would impact the care of children or a violation that would impact those services required to meet children's needs.) [;8J Yes Yes D No ONLY VISIT REPORTS DOCUMENTING TYPE A VIOLATIONS AND CORRECTIONS OF VIOLATIONS MUST BE POSTED IN THE CHILD CARE FACILITY FOR 30 CONSECUTIVE DAYS. Regardless of whether or not this child care facility is required to post a ccpy of today's site visit report, you may view the report at the facility or obtain one by contacting the local Child Care Regional Office at: LA Child Care East 1000 Corp. Ctr. Dr. Ste 2008 Monterey Park, CA 91754 Regional Office Contact Person: Danny Vergara Contact Person Telephone Number: 323-981-3431 THIS NOTICE MUST BE POSTED FOR 30 DAYS LIC9213 (FAS) (1/04) M STATE OF CALIFOFINlA. ~HEALTH AND HUMAN SERVICES AGENCY CAUFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY EVALUATION REPORT L.AChlld Cere Eaat,1000 Carp. Clr. Dr.Ste2009 Monte Park, CA9t754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: GUADALUPE GRIJALVA 151 N. OCCIDENTAL BLVD. ADDRESS: LOS ANGELES CITY: STATE:CA 90 CAPACITY: CENSUS: 68 UNANNOUNCED TYPE OF VISIT: Case Management MET WITH: Guadalupe Grijalva · FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 06/13/2006 02:00PM 04:30PM NARRATIVE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 LPA Danny Vergara arrived at the above facility for the purpose of conducting a case management visit. LPA discussed with director Grijalva parent rights. LPA provided Grijalva the following Health and Safety Code Section, 1596.857 (c) "If any child day care facility denies a parent or legal guardian the right to enter and inspect a facility or retaliates, the department shall issue the facility a warning cllation. For any subsequent violation of this right, the department may impose a civil penalty upon the facility of fifty dollars ($50) per violation. The department may take any appropriate action, including license revocation." LPA reminded Grijalva the facility has already been cited for the denial of parent rights, and if there are subsequent violations a penalty will be imposed. This concluded the purpose ofthe meeting, no deficiencies are being ctled on this report on this date, per the California Code of Regulations, Title 22, Division 12, Chapter 1. An exit interview was conducted, appeal rights were explained and a copy of this report was left wHh Grijalva. SUPERVISOR'S NAME: Georgia Brown TELEPHONE: (323) 981-3369 LICENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323-981-3431 LICENSING EVALUATOR SIGNATURE: -SIGNED- DATE: 06/13/2006 I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: -SIGNED- DATE: 06/13/2006 This report must be available at the facility for public review (3 years). LICOOG (FAS) - (06104) Page: 1 or 1 STATE OF CALIFORNIA- HEALTH AND HUMAN SERV1CES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DMSlON COMPLAINT INVESTIGATION REPORT LI.Chlld Care East,1000 Corp.Ctr. Dr. St9200B Montere Park, CA 91754 This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/05/2006 and conducted by Evaluator Danny Vergara PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20060605124641 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: GUADALUPE GRIJALVA ADDRESS: 151 N. OCCIDENTAL BLVD. CITY: LOS ANGELES STATE:CA 90 CAPACITY: CENSUS: 58 UNANNOUNCED MET WITH: Guadalupe Grijalva FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 06/13/2006 02:00PM 04:30PM ALLEGATION(S): 1 Reporting Requirements 2 - Facility fails to report to the parent regarding injuries and unusual incidents. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA Danny Vergara arrived at the above facility for the purpose of investigating the above allegation. LPA 2 reviewed the child's file and found several incident reports. The incident in question occurred on the school's 3 picture day, where LPA observed in a picture, a knot on the child's left forehead area for which there was no 4 incident/injury report. The facility was not able to provide any documentation regarding the injury, therefore it 5 cannot be determined whether an assessment was conducted to check ff the child required medical attention 6 for the injury. Based upon no documentation of the injury, and no notification to the parent regarding the 7 allegation has been substantiated. 8 9 10 11 12 13 According to the California Code of Regulations, Trtle 22, Division 12, Chapter 1, \he following deficiency is being cited. (see next page LIC 9099D) This is a subsequent deficiency within a 12 month period therefore an immediate civil penalty of $150 is being assessed, and $50 per day until the plan of correction is completed. An exit interview was conducted; appeal rights were explained and a copy of this report was left with Grijalva. Notice of Site Vis~. LIC 9213 was posted on this da , and must remain posted for 30 da . Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Georgia Brown TELEPHONE: (323) 981-3369 LICENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323-981-3431 LICENSING EVALUATOR SIGNATURE: ... SIGNED- DATE: 06/13/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ... SIGNED- DATE: 06/13/2006 This report must be available at the facility for public review (3 years). LICtl*ll (FAS)- (06/04) Page: 1 ot2 Control Number 33·CC·20060605124641 STATE 0!= CALIFORNIA· HEALTH AND HUMAN SERVJCES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVJCES COMMUNITY CARE UCENS!NG DMS!ON COMPLAINT INVESTIGATION REPORT (Cont) LAChUd em East, 1000Corp. Ctr. Dr. Ste 2008 Monter& Park, CA 91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Deficiency Type POC Due Data/ FACILITY NUMBER: 198011690 VISIT DATE: 06/13/2006 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number TypeB 06/14/2006 Section Cited 101212(d)(1 )(B) 1 2 3 4 5 6 7 1 LPA observed a picture of a knot on a child's head 2 3 which occurred on picture day. There was no Reporting Requirements documentation regarding the injury and the authorized representative was not notified of the injury. 1 2 3 4 5 6 7 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 1 2 2 3 4 5 3 4 5 6 6 7 7 Failure to correct the cited dellciency(les), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. SUPERVISOR'S NAME: Georgia Brown TELEPHONE: (323) 981·3369 UCENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323·981·3431 LICENSING EVALUATOR SIGNATURE: -SIGNED- DATE: 06/13/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: -SIGNED- LIC90e9 {FAS} • (06/04) DATE: 06/13/2006 Pago: 2 of 2 STATE OF CALIFORNIA· HEALTH AND HUMAN SERVICES AGENCY CALFORNIA DEPARTMENT OF SOCIAL SERVICES COMPLAINT INVESTIGATION REPORT LA. Child care East, 1000 Corp.ctr. Dr. ste200B Monterey Park. CA 91764 COMMUNITY CARE UCENSING DIVISK)N This is an official report of an unannounced visit/investigation of a complaint received in our office on 04{04/2006 and conducted by Evaluator Danny Vergara PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20060404150456 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: HOLLY GILLESPIE 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE:CA CAPACITY: 90 CENSUS: 82 MET WITH: Guadalupe Grijalva FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: UNANNOUNCED TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 05/23/2006 09:45 PJ./1. 10:30AM ALLEGATION(S): 1 Denial of Parent Rights 2 - Facility Is denying parent access to the facility. 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA Danny Vergara investigated the above allegation that the facility has denied a parent the rights to enter the 2 facility. The agency admits to denying the parent rights due to conflicts with the parent disrupting the program. 3 The agency informed the parent he would not be able to return to the facility. Basad upon the interviews 4 conducted, the allegation has bean determined substantiated. 5 6 According to the California Code of Regulations, Trtla 22, Division 12, Chapter 1, the following deficiency is 7 being cited. (see next page LIC 9099D) An exit interview was conducted, appeal rights were explained and a 8 copy of this report was left with the agency. 9 10 11 12 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Georgia Brown TELEPHONE: {323) 981-3369 LICENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323-981-3431 LICENSING EVALUATOR SIGNATURE: -SIGNED- DATE: 05/23/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ... SIGNED... DATE: 05/23/2006 This report must be available at the facility for public review (3 years). LIC900D (FAS) - (05/04) Page: 1 of 2 Control Number 33-CC-20060404150456 STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNFTY CARE LICENSING DMSION COMPLAINT INVESTIGATION REPORT (Cont) LA Child Care East, 1000 Corp.Ctr. Dr. Sta200B Monterey Pat11:, CA91754 FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER DEFICIENCY INFORMATION FOR THIS PAGE: Dollcloncy Type POC Duo Date/ FACILITY NUMBER: 198011690 VISIT DATE: 05/23/2006 DEFICIENCIES PLAN OF CORRECTIONS(POCs) Section Number TypeB 05/23/2006 SecUon Cited 101218.1(b)(1) 1 2 3 4 5 6 7 ADMISSION PROCEDURES AND PARENTAL AND AUTHORIZED REPRESENTATIVE'S RIGHTS A parent has been denied the rtght to enter the facility. 1 The agency will review the relationship with the 2 parent and will make a determination about 3 continued services rendered for the child. 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 1 2 3 4 5 6 7 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: Georgia Brown TELEPHONE: (323) 981-3369 LICENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323-981-3431 LICENSING EVALUATOR SIGNATURE: -SIGNED**" DATE: 05/23/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: ... SIGNED*** ucsm (FAS)- (06/04) DATE: 05/23/2006 Page: 2 of2 All POC Have Been Cleared STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNrTV CARE UCENSlNG DMSION CLEARED POC's LA Child Care East,. 1000 Corp. ctr. Or. Stu 2008 Monterey Park, CA91754 FACILITY NUMBER: FACILITY NAME: ST. ANNE'S EARLY LEARNING CENTER VISIT DATE: 05/23/2006 POC Due Date/ Section Number PLAN OF CORRECTIONS(POCs) 05/23/2006 101218.1(b)(1) 1 2 3 Th~ agency will review the relationship with the parent and will 4 f!lake a detennination about continued services rendered for 5 he child. 6 Date Cleared I Comments 1 2 3 4 7 Section Cited 1 2 3 4 5 6 7 Section Cited 1 2 3 4 5 6 1 2 3 4 1 2 3 4 7 1 Section Cited 2 3 4 5 6 7 1 2 3 4 05/23/2006 Corrected Immediately. A parent cannot be excluded from the facility unless he/she is a danger/threat at the time of the denial to access the facility. STATE OF CALIFORNIA- HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE UCENSING DMSION COMPLAINT INVESTIGATION REPORT IJ\Chlld care East.1000COrp.Ctr. or. Ste200B Monterey Park. CA 91764 This is an official report of an unannounced visit/investigation of a complaint received in our office on 03/14/2006 and conducted by Evaluator Danny Vergara PUBLIC COMPLAINT CONTROL NUMBER: 33-CC-20060314121 018 FACIUTY NAME: ST. ANNE'S EARLY LEARNING CENTER ADMINISTRATOR: HOLLY GILLESPIE 151 N. OCCIDENTAL BLVD. ADDRESS: CITY: LOS ANGELES STATE:CA 90 CAPACITY: CENSUS:63 UNANNOUNCED MET WITH: Guadalupe Grijalva FACILITY NUMBER: FACILITY TYPE: TELEPHONE: ZIP CODE: DATE: TIME VISIT BEGAN: TIME COMPLETED: 198011690 850 (213) 381-2931 90026 03/15/2006 12:00 PM 03:00PM ALLEGATION(S): 1 Personal Rights- Teacher pulled a child causing scratches on the back of the neck. 2 3 4 5 6 7 8 9 INVESTIGATION FINDINGS: 1 LPA Danny Vergara arrived at the above facility for the purpose of investigating an allegation of personal rights 2 violation, when a teacher pulled a child causing scratches on the back of the neck area. LPA Vergara met with 3 Early Learning Center Director- Guadalupe Grijalva. Grijalva acknowledges the incident occurred and was 4 notified immediately of the incident. Grijalva provided LPA a statement regarding the injury observed. LPA 5 interviewed the teacher- Lina Law. Law admits to grabbing the child by the collar and scratching the child, 6 when the child attempted to run away from a designated area. Based upon the interviews conducted, the 7 allegation that a child's personal rights were violated has been substantiated. 8 9 According to the California Code of Regulations, Trtle 22, Division 12, Chapter 1, the following deficiency has 10 been cited. (see next page LIC 9099D). 11 12 An exit interview was conducted, appeal rights were explained and a copy of this report was given to Grijalva. 13 Substantiated Estimated Days of Completion: SUPERVISOR'S NAME: Georgia Brown TELEPHONE: (323) 981-3369 LICENSING EVALUATOR NAME: Danny Vergara TELEPHONE: 323-981-3431 LICENSING EVALUATOR SIGNATURE: -SIGNED*"" DATE: 03/15/2006 I acknowledge receipt of this form and understand my appeal rights as explained and received. FACILITY REPRESENTATNE SIGNATURE: *'*SIGNED- DATE: 03/15/2006 This report must be available at the facility for public review (3 years). LIC9