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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400632
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:50:14 PM

Document Has Been Signed on 11/16/2022 02:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WORLDTOTS LAFACILITY NUMBER:
197400632
ADMINISTRATOR:PAMELA DALEFACILITY TYPE:
850
ADDRESS:100 W. FIFTH STREETTELEPHONE:
(310) 732-7697
CITY:SAN PEDROSTATE: CAZIP CODE:
90731
CAPACITY: 48TOTAL ENROLLED CHILDREN: 38CENSUS: 28DATE:
11/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Pamela DaleTIME COMPLETED:
02:00 PM
NARRATIVE
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On 11/16/2022, Licensing Program Analyst (LPA) Lillian Casillas conducted an unannounced Case Management – Incident inspection for the purpose of following up on a LIC 624 Unusual Incident Report (UIR) submitted on 11/8/2022. LPA met with Administrator, Pamela Dale, and explained the purpose of the visit. LPA observed 28 children with 9 staff.

According to the UIR, on 11/7/2022 at approximately 1:30PM, Child 1’s (C1) braid got stuck on a gate on the playground, and C1’s braid was pulled out. When Parent 1 (P1) picked up C1 and Child 2, P1 was notified of the incident verbally, and P1 was not provided an incident report.

During today’s inspection, LPA toured the inside and outside of the facility. LPA interviewed Administrator and 4 staff. Staff 1 (S1) admitted to not notifying P1 of the incident immediately and not providing an incident written for P1 at pickup. Administrator, S1, Staff 2 (S2), Staff 3 (S3), and Staff 4 (S4) corroborated that P1 was not notified immediately about the incident. Administrator, S1, S2, and S4 stated the incident report was written the next day on 11/8/2022.

Based on interviews and record review, LPA issued a Type B citation pertaining to parent notification of serious injuries (see LIC 9099D).

An exit interview was conducted, and a copy of this report, LIC 9213 Notice of Site Visit, and Appeal Rights were provided to Administrator, Pamela Dale.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Lillian J Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/16/2022 02:50 PM - It Cannot Be Edited


Created By: Lillian J Casillas On 11/16/2022 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WORLDTOTS LA
FACILITY NUMBER: 197400632

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/16/2022
Section Cited
CCR
101226(a)

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101226 Health-Related Services
(a) The licensee shall immediately notify the child's authorized representative if the child...sustains an injury more serious than a minor cut or scratch...
This requirement was not met as evidenced by:
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Administrator agreed to train staff on reporting requirements pertaining to injuries to the face or head of children, including training on writing timely incident reports to parents. Administrator agreed to provide a copy of the training agenda to LPA by EOD on 11/23/2022 via email.
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Based on interviews and record review, the Administrator failed to ensure P1 was immediately notified of C1’s head injury, which poses an immediate health, safety, or personal rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Lillian J Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022


LIC809 (FAS) - (06/04)
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