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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191290059
Report Date: 12/18/2019
Date Signed: 12/18/2019 10:45:26 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WOODCREST PRESCHOOLFACILITY NUMBER:
191290059
ADMINISTRATOR:JULIE ROBLESFACILITY TYPE:
850
ADDRESS:6043 TAMPA AVENUETELEPHONE:
(818) 345-3002
CITY:TARZANASTATE: CAZIP CODE:
91356
CAPACITY:137CENSUS: 76DATE:
12/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Julie RoblesTIME COMPLETED:
09:30 AM
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Margarit Sislyan, Licensing Program Analyst (LPA), met with Julie Robles, Director and conducted a case management inspection regarding an incident occurred at the facility on 11/8//2019. The incident was reported to CCLD (Community Care Licensing Department).

According to the incident report a two year old child tripped and fell on to the garden decoration causing a cut under the nose.

There were 10 children and 2 staff members (one teacher and one teacher assistant) in the yard.

Preschool director stated that the child continues attending the school. He is doing well.

There are no violations.

No complaint has resulted from this incident.

Exit interview.
SUPERVISOR'S NAME: Mary RuizTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Margarit SislyanTELEPHONE: (424) 430-3049
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2019
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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