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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198000822
Report Date: 10/19/2023
Date Signed: 10/19/2023 04:39:17 PM

Document Has Been Signed on 10/19/2023 04:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:GREENWOOD ELEMENTARY SCHOOLFACILITY NUMBER:
198000822
ADMINISTRATOR:MARIANA SANCHEZFACILITY TYPE:
850
ADDRESS:900 S. GREENWOOD AVE.TELEPHONE:
(323) 887-7900
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY: 42TOTAL ENROLLED CHILDREN: 42CENSUS: 25DATE:
10/19/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Lead Teacher Lydia MartinezTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management- Incident inspection at the above facility on 10/19/23 at 02:18 p.m. LPA met with teacher Julia Mojarro and Lead Teacher Lydia Martinez. LPA took a tour of the facility.This is a Head Start preschool program which is operated by Montebello Unified School District and is located on the premises of Greenwood Elementary School. Per Teacher Julia, there are (3) sessions under this license: AM, PM, and Full day. LPA also observed the PM classroom in session. The AM session staff and children were not present. Census was taken for both sessions.

The purpose of this inspection is to follow up on (2) unusual incident reports that occurred on 08/30/23 and 09/15/23 and were not reported to the Department within the required 24 hours.

Regarding the first unusual Incident report, the facility had 5 COVID cases that were not reported to the Department. The Department was notified by the Department of Public Health on 09/08/23 that the facility had a COVID outbreak. LPA contacted the facility to follow up on the COVID outbreak, took the initial report, and advised the facility contact that all COVID cases (3) or more must be reported to the Department within 24 hours. The written report was received on 09/13/23 and the facility was cleared by Department of Public Health.

Regarding the second unusual incident report, facility staff left 2 children unattended in the facility playground. The Department received the unusual incident report on 09/25/23; however, the incident occurred on 09/15/23. Per Staff #1 (S1), 2 children were observed to be sitting on the benches located inside the facility. S1 parks in the staff parking lot and must go through 2 locked fences before arriving at the site. S1 observed from a distance 2 children sitting on the benches, however, S1 assumed that those children belonged to the elementary school. As S1 got closer to the facility playground, S1 recognized both children who belong to the AM session. S1 brought the children into the classroom when S2 returned from the cafeteria to pick up the children that were left unattended. According to S1, the exact time the children were left unattended is unknown.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK CC RO, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: GREENWOOD ELEMENTARY SCHOOL
FACILITY NUMBER: 198000822
VISIT DATE: 10/19/2023
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S1 usually arrives 15 minutes before the PM session begins and the approximate time children were taken to the classroom was at 11:05 a.m. Per S2, children were in the playground and were told to stay in their area and to not move. It was lunch time for the AM session, S2 and S3 gathered all children in the AM session and walked over to the cafeteria. Per S2, children lined up outside of the cafeteria when suddenly S3 asked S2 how many children they had all together. S2 stated that S3 asked how many children were with S2 to which S2 replied “none” since the children can’t come into the cafeteria. S2 immediately counted all children and realized that 2 children were left in the playground. Per S2, immediately returned to the playground and found that the 2 children were in the classroom with the lead teacher for the PM session. S2 does not recall how many children were present on 09/15/23. On the unusual incident report, S2 and S3 admitted that they “did not count the children and 2 children were left on the playground.”

The following deficiency listed on the attached LIC 809D (deficiency page) is being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

LPA Veronica MartinezGarza informed Lead Teacher that this report dated 10/19/23 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Veronica MartinezGarza informed the Lead teacher Lydia Martinez to provide a copy of this licensing report dated 10/19/23 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative, a civil penalty of $100 can be assessed.

Exit Interview was conducted, and appeal rights were given, along with a copy of this report was provided to the Lead Teacher Lydia Martinez.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 10/19/2023 04:39 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 10/19/2023 at 03:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GREENWOOD ELEMENTARY SCHOOL
FACILITY NUMBER: 198000822

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/27/2023
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision ....No child(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.
This requirement is not met as evidenced by:
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Per Lead Teacher, she will reach out to the Assistant Director for guidance on what the the plan of correction will be and will submit proof to LPA by POC due date. LPA recommends facility to review with staff supervision and personal rights regulations. Also to provide training for all staff.
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2 children were left unattended in the facility playground for an unknown time frame.
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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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 10/19/2023 04:39 PM - It Cannot Be Edited


Created By: Veronica Martinez-Garza On 10/19/2023 at 03:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: GREENWOOD ELEMENTARY SCHOOL
FACILITY NUMBER: 198000822

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/27/2023
Section Cited
CCR
101212(d)(1)(c)

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d) 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 Department by telephone or fax within the Department's next working day and during its normal business hours. ....(1) Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
This requirement is not met as evidenced by:
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Per Lead Teacher, she will reach out to the Assistant Director for guidance on what the the plan of correction will be and will submit proof to LPA by POC due date. LPA recommends facility to review with staff the reporting requirements regulation. Also to provide training for all staff.
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The facility did not report to the Department within the required 24 hours that the facility had a COVID outbreak and that 2 children were left unattended in the playground
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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:Ana Chico
LICENSING EVALUATOR NAME:Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023


LIC809 (FAS) - (06/04)
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