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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607576
Report Date: 03/26/2025
Date Signed: 03/26/2025 12:55:13 PM

Document Has Been Signed on 03/26/2025 12:55 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SANTA MONICA-MALIBU USD/GRANT H.S./S.PFACILITY NUMBER:
191607576
ADMINISTRATOR/
DIRECTOR:		ALICE CHUNGFACILITY TYPE:
850
ADDRESS:2368 PEARL STREETTELEPHONE:
(310) 450-7684
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY: 44TOTAL ENROLLED CHILDREN: 14CENSUS: 13DATE:
03/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Reham Dabash- Assistant DirectorTIME VISIT/
INSPECTION COMPLETED:
01:10 PM
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On 03/26/2025 at 9:05 a.m. Licensing Program Analyst (LPA)Doris Whitmore conducted an unannounced visit for conducting a Case Management Inspection for an incident that occurred on 02/26/2025 and was reported to the Regional Office. LPA met with Reham Debash and informed the nature of the visit. At the time of the visit there was 13 children and 2 teachers.

According to the UIR during music and movement time when staff 1 told everyone to turn around child 1 jumped instead. Child 1 tripped and hit his face. Child 1 had a cut above his right eyebrow. Staff 1 did first aid and applied pressure. Staff 1 called child 1’s parents to pick him up. Child 1 was taken to the doctor. RP stated they are waiting for child 1’s mother to send the doctor’s note to the school’s nurse, Child1’s mother reported to RP that child 1 had to get 3 stiches and child 1 will have some restrictions. Child 1 is expected to return to school tomorrow 2/27/2025. LPA Whitmore obtained the following documents Doctor's Note, Personnel Report, Head Injury Report, Sign In Sheet.

LPA Whitmore interviewed the two teachers and and two children. LPA Whitmore interviewed (C1), during the interview (C1) stated that he hit his head and that (S1) helped him. ( C1) stated that his daddy took him to the doctor and the doctor checked his head, and fixed it. LPA Whitmore interviewed ( C2). during the interview ( C2) pointed to her head and said eyebrow and then there was blood.( C2) stated that ( C1) got a stitch and she helped him up. In interviewing( S1) stated that there were two teachers the day of the incident. The incident occurred on the rug. ( S1) stated that the class came back from a fire drill and the children sat on the carpet. During music and movement they were in a circle and each child was on their dot. When the children were dancing to the song Hokey Pokey. Right where the song said turn around, (C1) jumped and turned around.( C1) fell forward and hit his forehead on the shelf. Nothing was on the floor. Parents were notified and first aid was administered. (S2) stated during the interview that there were two teachers

NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Doris Whitmore
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SANTA MONICA-MALIBU USD/GRANT H.S./S.P
FACILITY NUMBER: 191607576
VISIT DATE: 03/26/2025
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 the day of the incident. The class was dancing to some songs. The kids were dancing in a circle.( S2) did not observe when the incident exactly happened. ( S2) stated that she only observed when ( C1) went down. and that ( S1) notified the parent. ( C1) was cared by ( S1) and ( S2) cared for the other children. During the interview ( S2) stated there was a cut above the eyebrow. ( S2) stated that she only sub for one day. In conclusion mother emailed the main teacher the doctors note. LPA Whitmore read the doctors note which stated that ( C1) was seen in the emergency department on 02/25/2025 and may return to school on 02/27/2025.(C1) had to get 3 stitches. LPA Whitmore read the Head Injury Report and checked the area where the incident occurred.
In conclusion there are no deficiencies or a lapse of Care and Supervision. An exit interview was conducted, notice of site visit and appeal rights were issued to Reham Debash, Assistant Director. LPA Whitmore informed Reham Dabash that the Notice of Site Visit must be posted for 30 days. Notice of Site Visit was posted before LPA Whitmore left the facility.
NAME OF LICENSING PROGRAM MANAGER: Karren Starks
NAME OF LICENSING PROGRAM ANALYST: Doris Whitmore
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC809 (FAS) - (06/04)
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