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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200386
Report Date: 08/15/2019
Date Signed: 08/15/2019 01:23:01 PM

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:PARENTS AND CHILDREN'S NURSERY SCHOOLFACILITY NUMBER:
191200386
ADMINISTRATOR:MARJORIE GOLDENFACILITY TYPE:
850
ADDRESS:4603 INDIANOLA WAYTELEPHONE:
(818) 790-2103
CITY:LA CANADASTATE: CAZIP CODE:
91011
CAPACITY:80CENSUS: 0DATE:
08/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:26 PM
MET WITH:Marjorie GoldenTIME COMPLETED:
01:37 PM
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Licensing Program Analyst (LPA) Justin Dorsey conducted an unannounced case management on this date for the purpose of addressing an incident that was reported to the Department. LPA met with Director Marjorie Golden. Children were not in care at the time of this visit because of summer break. Per Director children will return on 09/03/19.

On 07/16/19, the Department received an unusual incident/injury report regarding a child sustaining a fracture to their left arm. Per the report, on 0722/19 Child #1 was climbing the apparatus in the Senior Play ground and fell. The child fractured his left arm, first aid was applied to the child and the parent was informed.

During the visit LPA conducted an interview with Director. During the interview it was found that the Child #1 fell off of the play equipment and broke his arm. Per Director the facility was not notified that the child had a broken arm until after the incident occurred because the parent did not call the school. LPA was unable to interview Staff #1 who witnessed the child fall because she won't be back at the facility until 09/03/19.

Additional investigation will be conducted in order to obtain documentation and conduct further interviews.

Exit interview was conducted with Director Marjorie Golden, Notice of Site Visit and Appeal Rights were given.

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2019
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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