191600755-10-13-2022-58-CC-DMIA-CK6MXV-20221013100034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191600755
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:00:39 AM

Document Has Been Signed on 10/13/2022 10:00 AM - 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 CHURCH		FACILITY NUMBER:	191600755
ADMINISTRATOR:	BRIANNE NAIMAN		FACILITY TYPE:	850
ADDRESS:	10822 WILSHIRE BLVD		TELEPHONE:	(310) 474-2889
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90024
CAPACITY:	80	CENSUS:	DATE:	10/13/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Brianne Naiman, Director		TIME COMPLETED:	10:10 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 10/13/2022, 8:35am 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. LPA met with Brianne Naiman, Director. Upon arrival, LPA observed 44 children with 13 staff providing care and supervision. 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 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 doctor’s notes that Child#1 could 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. Based on the information obtained throughout the course of the investigation, LPA conducted interviews with staff and children involved on this incident and obtained support documents. During interview it was revealed that Child#1 and Child#2 were playing at the playground structure and not at the round latter when Child#2 pushed Child#1. Both children disclosed that both need space to play at the playground structure. LPA inspected the play yard and observed that the equipment have a label with age appropriate and in good repair.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 CHURCH	FACILITY NUMBER: 191600755
	VISIT DATE: 10/13/2022

NARRATIVE

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Facility provided information about the age appropriated of the structures.
At the time of the incident, teacher to child ratios were within compliance. Facility staff provided proper care and supervision during the time of the incident. Facility applied first aid. The mother of the child was immediately notified and sought medical assistance after the incident. The child remains enrolled in the above day care.

The facility also followed Title 22 Regulations in reporting the incident to the Community Care Licensing Division.
It does not appear that the incident was a result of a Title 22 violation.

LPA advised to the Director to create a zone area to make sure, staff have a zone stage closed the stairs and the round latter equipment located at the playground area. During this visit, Director provided a copy of the playground structure point the zone stage for each staff while they are providing care and supervision at the playground. Director conducted training with her staff, regarding yard agreements, reporting requirements, care and supervision.

An exit interview was conducted, and a copy of this report was provided to Brianne Naiman, Director.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC809 (FAS) - (06/04)

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