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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600755
Report Date: 09/14/2022
Date Signed: 09/14/2022 02:12:30 PM


Document Has Been Signed on 09/14/2022 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:WESTWOOD PRESBYTERIAN CHURCHFACILITY NUMBER:
191600755
ADMINISTRATOR:BRIANNE NAIMANFACILITY TYPE:
850
ADDRESS:10822 WILSHIRE BLVDTELEPHONE:
(310) 474-2889
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:80CENSUS: 67DATE:
09/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Brianne Naiman, Director TIME COMPLETED:
02:20 PM
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On 09/14/2022, 11:10am Licensing Program Analyst (LPA) Denise Miranda arrived at the facility for the purpose of following up on an unusual incident that occurred at the facility on 09/1/2022. The facility reported the incident on 09/1/2022.

According to the report, on 09/1/2022, at 9:50am, during the children’s yard time, child#1 and child#2 were playing on the play structure. Child#2 started to climbing the round latter apparatus when child#1 was attempting to climb the round ladder behind him. Child#2, pushed Child#1 causing him to fall. Child#1 landed on the floor on his right arm. Teacher#2 who was helping in the sandbox helped Child#1. Child#1 was able to stand up and on his own. Child#1 was took to the main office, and ice was applied on his wrist. Parents were called and recommended to take to the doctor. Per parents, doctor determined that Child#1 had a broken wrist. The parents provided a doctors notes that Child#1 could returned and returned back to school the following day with cast on. Teachers from the classes that were on the yard meet to discuss that what happened and actions to take moving forward.

During this inspection, LPA conducted interviews with facility staff and the children involved in the incident. LPA also obtained copies of the sign and sign out sheet dated 09/01/2022, yard agreement, teacher week agenda dated on 08/15/2022, LIC500 Personnel Report, and Doctor’s notes (child#1).

During inspection, LPA observed that facility missing the label of age appropriate of structure. Technical advisory was issued. At this time, further investigation is needed.

An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Brianne Naiman, Center Director.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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