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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191594914
Report Date: 07/27/2021
Date Signed: 07/27/2021 03:51:29 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:CERRITOS COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
191594914
ADMINISTRATOR:DEBRA WARDFACILITY TYPE:
850
ADDRESS:11110 ALONDRA BLVDTELEPHONE:
(562) 860-2451
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:125CENSUS: 17DATE:
07/27/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Debra Ward, DirectorTIME COMPLETED:
04:00 PM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) A. Lucero to address an Unusual Incident Report that was received in the licensing office on 07/16/2021. LPA met with Director Debra Ward who guided LPA on a tour of facility of both indoors and outdoors.

On 07/16/2021, child #1 was playing in the Bumpy Slide play structure area when the child was attempting to switch over to the balancing steps. Upon stepping, child lost balance causing them to fall face forward onto the balancing beam and hitting the right side of their forehead above the eyebrow area. First aid was administered. Paramedics were called and took the child to the hospital. Child's authorized representative was notified.

Per correspondences between facility and authorized representative, child can return to normal activities. Child has yet to return to school; facility will request a doctor's clearance note upon arrival and submit to LPA via email.

Based on all information obtained on this date, and interviews conducted with teachers, follow-up may or may not be necessary regarding the incident. The incident appears to be an unusual accident. It appears that the child lost their footing on the balancing step causing them to fall forward. LPA observed the balancing step to be stable, firmly in place. LPA stood on top of the balancing step and observed the balancing step to be non-slip. LPA obtained photo of balancing step. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1
SUPERVISOR'S NAME: Valarie CookTELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Armando J LuceroTELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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