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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600755
Report Date: 04/03/2024
Date Signed: 04/03/2024 11:24:57 AM


Document Has Been Signed on 04/03/2024 11:24 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 CHURCHFACILITY NUMBER:
191600755
ADMINISTRATOR:BRIANNE NAIMANFACILITY TYPE:
850
ADDRESS:10822 WILSHIRE BLVDTELEPHONE:
(310) 474-2889
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY:80CENSUS: 58DATE:
04/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Brianne Naiman, DirectorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Brittanee Cleveland conducted an unannounced case management inspection due to an incident that occurred on 03/22/2024. LPA arrived at the facility at 8:30AM and met with Brianne Naiman, Director, who guided LPA on a tour of the facility. There were 58 children and 13 staff present upon arrival. The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA Cleveland conducted interviews with staff, child, and parent. LPA obtained documentation during this visit.

The incident that occurred on 03/19/2024, was reported to the facility on 03/22/2024 by parent, and reported to the Department on 03/22/2024, via telephone by Director. The facility reported the Unusual Incident to the Department within the required 24 hours of notification.

Information reported to the Department indicated that child #1 (C1) was playing with child #2 (C2) and adult 1 (A1) arrived to pick up C1. Staff 2 (S2), who was nearby assisting with other child, heard the impact of C1 and C2. S2 witnessed C1 fall to ground and head hit ground and bounced. A1 picked up C1 to assess him for injury. S3 heard C1 crying. S2 provided an ice pack for C1. A1 took C1 home due to no notable injuries. On 03/22/2024, A1 contacted S1 stating that C1 was taken to emergency room for a headache and C1 started vomiting, which A1 thought C1 had a virus. After being tested by pediatrician, A1 was informed of C1’s mild concussion. Facility required a doctor’s note and/or clearance before child can return to care.

Child #1 returned to care on 04/02/2024. There was spring break from 03/25/2024 to 04/01/23. A1 provided facility with a doctor's note on 03/22/2024. No restrictions were documented on the doctor’s note. A1 did tell facility she wanted C1 on restricted play when he returns on 04/02/2024. C1 was taken off restricted play on 04/03/2024. ---- Page 1

SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Brittanee ClevelandTELEPHONE: 424-301-3050
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2024
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: 04/03/2024
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Based on interviews conducted and documentation obtained, there were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.



Exit interview conducted and report was reviewed with Brianne Naiman, Director.

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SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Brittanee ClevelandTELEPHONE: 424-301-3050
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC809 (FAS) - (06/04)
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