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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200386
Report Date: 09/11/2019
Date Signed: 09/11/2019 10:19:12 AM

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: 66DATE:
09/11/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Marjorie GoldenTIME COMPLETED:
10:33 AM
NARRATIVE
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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. During the visit there were 66 children present

On 07/22/19, the Department received an unusual incident/injury report regarding a child sustaining a fracture to their left arm. Per the report, on 07/16/19 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 and Staff #1. During the interview it was found that 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. Per Director and Staff #1 the child returned to the facility on 07/18/19 with a soft cast. Per Director and Staff #1 the facility was not aware that the child broke his arm until 07/22/19, when the child came to the facility with a hard cast.

During the visit the facility was given a Type B citation. Please refer to the LIC 809D page for details.

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: 09/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2019
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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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: PARENTS AND CHILDREN'S NURSERY SCHOOL
FACILITY NUMBER: 191200386
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2019
Section Cited

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101212 Reporting Requirements (d)(1)(B) 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. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any injury to any child that requires medical treatment. This requirement is not met as evidenced by:
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Based on interview the facility did not report a child's injury to the department by the next working day, which poses a portential Health, Safety or Personal Rights risk to 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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2019
LIC809 (FAS) - (06/04)
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