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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418547
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:04:50 PM

Document Has Been Signed on 03/08/2022 02:04 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:IKAR EARLY CHILDHOOD CENTERFACILITY NUMBER:
197418547
ADMINISTRATOR:JANE ROSENFACILITY TYPE:
850
ADDRESS:1564 BURNSIDE AVENUETELEPHONE:
(323) 634-1870
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY: 54TOTAL ENROLLED CHILDREN: 54CENSUS: 22DATE:
03/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Dr. Jane RosenTIME COMPLETED:
02:00 PM
NARRATIVE
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On 03/08/2022, Licensing Program Analyst (LPA) Sabrina Martinez conducted a Case Management- Deficiencies visit for the purpose of citing for the deficiencies that were observed during the investigation of Complaint CONTROL NUMBER 30-CC-20211215152647.

LPA met with Licensee Dr. Jane Rosen and discussed the purpose of the visit. There were 22 children in care at the time of this visit.

According to the report, on 11/10/2021 at around 12:15 PM, Child #1 played on the “Jump-a-roo” equipment and while coming off the equipment, Child #1 fell backwards and hit their head.

On 12/17/2021, Licensing Program Analyst (LPA) Sabrina Martinez conducted a visit at the facility. During the visit, LPA conducted interviews with facility staff. LPA also inspected the playground area and observed the location of the “Jump-a-roo” jumping equipment. LPA observed this equipment near the playhouse area. LPA observed that underneath the “Jump-a-roo” is a fake grass/turf material. LPA observed that there’s no cushioning material underneath the fake grass/turf material. LPA also obtained a copy of the parent handbook which states that “Minor accidents will be reported daily in a written incident report. All accidents will have an incident report filed in the child's file and a copy sent home that day.” Although the incident was reported to the parent via text, facility failed to provide a copy of the written incident report to the parent that day.

The facility was issued Type B citations in violation of Title 22 regulations. (See LIC 809-D for deficiency page).

An exit interview was conducted with Licensee Dr. Jane Rosen. A copy of this report, Notice of Site Visit, and appeal rights were provided to Licensee.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Sabrina Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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 03/08/2022 02:04 PM - It Cannot Be Edited


Created By: Sabrina Martinez On 03/08/2022 at 01:21 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: IKAR EARLY CHILDHOOD CENTER
FACILITY NUMBER: 197418547

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2022
Section Cited
CCR
101238.2(e)

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Outdoor Activity Space, As a condition of licensure, the areas around and under high climbing equipment, swings, slides and other similar equipment shall be cushioned with material that absorbs falls.

This requirement is not met as evidenced by: On 11/10/2021, Child #1 fell while coming
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Licensee was advised to move the equipment to another part of the outdoor yard where there’s cushioning material. Licensee was informed that a supervising adult should always be present when children are using the equipment. Licensee will send photos of the location of the equipment on or before March 15, 2022.
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off the “Jump-a-roo” equipment and hit the back of head on the pavement. The jumping equipment was placed directly on fake grass/turf and did not have a cushioning material that absorbs falls. This is a Type B violation and poses a potential threat to the health and safety of children.
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Type B
03/15/2022
Section Cited
CCR101173(d)

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Plan of Operation. The child care center shall operate in accordance with the terms specified in the plan of operation.

This requirement is not met as evidenced by: On 11/10/2021, facility did not operate in accordance with the terms specified in the plan of operation by failing to provide a
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Licensee to submit a written plan on how facility will adhere and operate in accordance with the terms specified in the plan of operation. Plan of correction due by March 15, 2022.
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written incident report to Child’s parents.

This is a Type B violation and poses an immediate risk to the health and safety of 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:Sabrina Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022


LIC809 (FAS) - (06/04)
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