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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200386
Report Date: 11/19/2019
Date Signed: 11/19/2019 10:16:47 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: 59DATE:
11/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marjorie GoldenTIME COMPLETED:
10:30 AM
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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, who gave LPA a tour of the facility. During the visit there were 59 children present.

On 10/29/19, the Department received an unusual incident/injury report regarding an incident on 10/29/19 involving Child #1. Per the report Child #1 was climbing on the play structure in the park play ground when she slipped and hit her chin on the ladder. Per Director, Teacher #1 and Teacher #2 the child sustained a cut on the chin and began to slightly bleed.

During the visit LPA conducted an interviews with Director, Teacher #1 and Teacher #2. During the interviews it was found that Child #1 was climbing the play structure in the playground, slipped and hit her chin on the ladder. Per Director and Teachers first aid was applied to stop the bleeding and the child's mother was contacted. The child was taken to urgent care and the cut was glued. According to Teacher #1 the child returned to school her next scheduled day.

Exit interview was conducted with Director Marjorie Golden, The Notice of Site Visit and Appeal Rights were given.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3351
LICENSING EVALUATOR NAME: Justin DorseyTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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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