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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198018225
Report Date: 03/19/2024
Date Signed: 03/19/2024 03:12:30 PM

Document Has Been Signed on 03/19/2024 03:12 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PARA LOS NINOS HEAD START - HOLLYWOODFACILITY NUMBER:
198018225
ADMINISTRATOR:ANGELA CAPONEFACILITY TYPE:
850
ADDRESS:5000 HOLLYWOOD BLVDTELEPHONE:
(213) 250-4800
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: DATE:
03/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Vanessa Quezada, Area SupervisorTIME COMPLETED:
03:30 PM
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On March 19, 2024, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. The purpose of this inspection is to follow up on an unusual incident report that occurred on 03/13/2024 and was filed with our department on 03/13/2024. The report was reported on time. LPA met with Area Supervisor, Vanessa Quezada. LPA observed 38 children in care with 7 staff.

Brief Summary of Incident: On 03/13/2024 at approximately 10:05am, while playing outside Child #1 (C1) pulled a plant/leaves (Calla Lillies) behind the fence (courtyard) and bit it. This caused C1 to have an allergic reaction. C1's lips were red and swollen. C1 was drooling and C1's started to itch. The facility called the parents of C1 and called 911. C1 was transported to the emergency room where C1 was observed.

During this investigation, LPA interviewed, staff #1 (S1), staff #2 (S2), staff #3 (S3), obtained a copy of incident report, obtained images of where the plant was located, obtained images of the plant, LPA reviewed the sign in/sign out sheets for children and staff that were present on that day of the incident, obtained a copy of the facilities children's roster and other relevant documents.

During interviews with S1, S2 and S3 it was disclosed that the classroom was within ratio and that S1 observed the incident occur. Per S1, she saw when C1 pulled the plant and bit it. Per S1, she immediately took the leaf of the plant and had C1 rinse his mouth out. Per S1-S3, staff #4 (S4) saw C1's lips swelling and turning red and S4 brought C1 into S3's office.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: PARA LOS NINOS HEAD START - HOLLYWOOD
FACILITY NUMBER: 198018225
VISIT DATE: 03/19/2024
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Per S3, S4 was calling C1's parents while S3 called the school nurse. Per S3, C1's parents did not answer and it was advised by the school nurse to call 911. Per S3, paramedics arrived at the facility at approximately 10:21am and observed C1. Paramedics advised for C1 to be taken into the emergency room for observation. Per S3, S4 rode with C1 in the paramedics. S3, stated that parents returned the call to the facility by 10:40am and were notified of the incident. S3 provided doctors notes to LPA clearing C1 to return to school. Per S3, there is no allergy history for C1.

LPA observed the where the plant was located and observed that the plant is not located inside the facility but is located outside of the facilities entrance gate. The plant was removed on 03/13/2024 the plant was removed from the outside area of the gate. LPA observed the facility to be in ratio the day of the incident with 11 children and 2 staff present during the time of the incident. Per S1-S2, they reminded that children not to pull the plants or put anything in their mouths as they have become curious with plants since their learning topic currently is, "Gardening Study".

The incident appears to be a accident that was not able to be prevented as it occurred quickly. The facility is found to be in compliance with Title 22 Regulations and is not being cited any deficiencies.

An exit interview was conducted and a copy of this report was provided to Area Supervisor, Vanessa Quezada. A Notice of Site Visit was provided; Notice of Site Visit must be posted to 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC809 (FAS) - (06/04)
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