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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600755
Report Date: 10/23/2024
Date Signed: 10/28/2024 02:50:39 PM

Document Has Been Signed on 10/28/2024 02:50 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/
DIRECTOR:		BRIANNE NAIMANFACILITY TYPE:
850
ADDRESS:10822 WILSHIRE BLVDTELEPHONE:
(310) 474-2889
CITY:LOS ANGELESSTATE: CAZIP CODE:
90024
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 54DATE:
10/23/2024
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Brianne Naiman, DirectorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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***This is a transcribed version of a report completed on 10/23/2024. Due to computer malfunction, a written report was provided. A hard copy with signature is on file.***

Licensing Program Analyst (LPA) Lilia Hernandez and Investigator Natisha Mendez conducted an unannounced annual inspection to the above facility on 10/23/2024. LPA and Investigator arrived at the facility at 9:10AM, identified selves and met with Brianne Naiman, Director, who guided analyst and investigator on a tour of the facility. LPA Hernandez provided Director with a copy of the LIC 125 Entrance Checklist.

There were 54 children and 12 staff present.

During the course of the inspection the facility was found deficient in the following and cited:

Type B: Staff Records - Type B: 1596.7995(a)(1) - 2 of 6 personnel files did not have proof of influenza or waiver.
Type B: Children Records - 101221(b)(4) - LPA observed various dates of admission for children enrolled; Type B: 101221(b)(5) - LPA observed incomplete LIC 700 forms in 6 of 6 children records reviewed

Type B: Physical Plant - 101238.2(d)(2) - LPA observed exposed rusted utility pipes where children play outdoors ( photo taken)

---End of report.
Rita RamosTELEPHONE: (424) 301-3061
Lilia HernandezTELEPHONE: 424-301-3071
DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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Document Has Been Signed on 10/28/2024 02:50 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238.2(d)(2)
Outdoor Activity Space
(d) The surface of the outdoor activity space shall be maintained: (2) Free of hazards including, but not limited to, holes, broken glass and other debris, and dry grasses that pose a fire hazard.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in LPA observed exposed rusted utility pipes where children play outdoors ( photo taken) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2024
Plan of Correction
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Per Director, a request will be submitted to have utility pipes inaccessible to children. Area will be inaccessible to children until repairs are complete.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 2 of 6 personnel files did not have proof of influenza or waiver which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2024
Plan of Correction
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Submit via email to LPA (Influenza vaccine or waiver)
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/28/2024 02:50 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101221(b)(4)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (4) Date of Admission.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in LPA observed various dates of admission for children enrolled which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/30/2024
Plan of Correction
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LIC 9040 Facility Roster with correct dates of admission to LPA via email.
Type B
Section Cited
CCR
101221(b)(5)
Child's Records
(b) Each record shall contain information including, but not limited to, the following: (5) Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in LPA observed incomplete LIC 700 forms in 6 of 6 children records reviewed which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/06/2024
Plan of Correction
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LIC 700 completed forms for all children will be submitted to LPA via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rita RamosTELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Lilia HernandezTELEPHONE: 424-301-3071
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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