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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191608256
Report Date: 01/24/2020
Date Signed: 01/24/2020 01:24:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LAKESHORE KIDS & CO. DAY CARE CENTERFACILITY NUMBER:
191608256
ADMINISTRATOR:BASS-NICHOLS, M.FACILITY TYPE:
850
ADDRESS:2695 E. DOMINGUEZ STREETTELEPHONE:
(310) 537-8600
CITY:CARSONSTATE: CAZIP CODE:
90895
CAPACITY:60CENSUS: 41DATE:
01/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Kathy Jewel & Rosa SanchezTIME COMPLETED:
01:44 PM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Raul Navarro to address an Unusual Incident Report that was received in the licensing office on 01/14/2020. LPA met with Co-Director Kathy Jewel who guided LPA on a tour of facility of both indoors and outdoors. Co-Director Rosa Sanchez arrived shortly after.

On 01/13/2020, Child #1 was standing on top of a chair when Child #2 pushed Child #1 causing Child #1 to fall and hit themselves on a plant. Child #1 sustained a small cut under her eyebrow. Child #1 was administered first aid and parent was called. Parent took child to urgent care where steri-strips were applied. Child did not require stitches.

LPA interviewed staff present when incident occurred. Staff #1 stated they did not observe the incident while it happened but was inside the classroom. Staff #2 observed the incident as it happened. Staff #2 was tending to another child and was unable to stop the incident from happening. LPA reviewed sign in and out sheets for the day of the incident. There was a total of 18 children with 3 staff members. Based on all information obtained and interviews conducted with teachers, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.

Exit interview was conducted with Co-Directors Kathy Jewel and Rosa Sanchez. LPA provided Co-Directors a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these forms.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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