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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494325
Report Date: 05/28/2025
Date Signed: 05/28/2025 03:45:42 PM

Document Has Been Signed on 05/28/2025 03:45 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CRYSTAL STAIRS HEAD START - CHAPEL OF PEACEFACILITY NUMBER:
197494325
ADMINISTRATOR/
DIRECTOR:		CARDENAS, LAURAFACILITY TYPE:
850
ADDRESS:1009 NORTH MARKET STREETTELEPHONE:
(323) 421-1100
CITY:INGLEWOODSTATE: CAZIP CODE:
90302
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 37DATE:
05/28/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Norma Izucar- Site SuoervisorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 04/7/2025 at 1:17 p.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection for an incident that occurred on 03/14/2025. and was reported to the Regional Office. LPA met with Site Supervisor, Norma Izcuar and informed the nature of the visit. At the time of the visit there were 45 children and 9 teachers.

According to the UIR During circle time C1 slipped and fell, hitting the corner of the table and injuring his right eyelid, causing a cut that that made him bleed incident occurred in the classroom.

LPA Whitmore interviewed S1 and C2 During the visit Site Supervisor shared that C1 has transferred to another facility. C1 transferred on 03/18/2025. LPA Whitmore called the parent of C1 and there was no answer. LPA Whitmore left a message and contact information. During the interview S1 stated that right before C1 fell when leaving group circle time to pick his individual choice time. to play. S1 was able to show LPA Whitmore where the child fell. The parent was notified, and first aid was administered and a copy of the incident report was given to the parent. Mom verbally told S1 that she took C1 to urgent care and was advised to follow up with his primary care physician.

On 05/05/2025 LPA Whitmore conducted a collateral visit to C1 ’s home to interview. LP attempted to interview C1, who did not respond to questions asked by LPA. Parent of C1 was interviewed as well. Parent told LPA that C1 got a cut in the upper right corner of the eye.Then when LPA asked if C1 needed to go to urgent care, staff said they couldn’t tell me that, I just needed to pick C1 up. Dad went to pick C1 up. It took 30 minutes to get an incident report from the center filled out. Parent had to wait for the incident report, staff would not let him leave without it. By the time we got to urgent care the doctor told us it was too late to stich it up. When I called the school, I asked them what happened and what occurred no one could tell me. I asked for pictures; it took them almost 20 to 30 minutes to get me the picture. When I received the picture, my

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Doris Whitmore
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CRYSTAL STAIRS HEAD START - CHAPEL OF PEACE
FACILITY NUMBER: 197494325
VISIT DATE: 05/28/2025
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 husband was already at the school. During the interview, LPA Whitmore asked the parent, if she had any documentation from the doctor. The parent stated that she could request it. To date parent has not submitted documentation.

Based on interviews conducted and information obtained, there was nothing observed in the area to have caused the child to fall. S1 was present providing visual supervision but was unable to prevent the child from falling. Therefore, there are no deficiencies being cited. A copy of this report along with the notice of site visit were issued to Site Supervisor, Norma Izucar.

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Doris Whitmore
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025
LIC809 (FAS) - (06/04)
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