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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609328
Report Date: 11/07/2019
Date Signed: 11/07/2019 02:31:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ROLLING HILLS COVENANT CHURCH PRESCHOOLFACILITY NUMBER:
191609328
ADMINISTRATOR:ENSLEY MORGANFACILITY TYPE:
850
ADDRESS:2222 PALOS VERDES DR. NORTHTELEPHONE:
(310) 519-9406
CITY:ROLLING HILLS ESTATESTATE: CAZIP CODE:
90274
CAPACITY:70CENSUS: 5DATE:
11/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Ensley Morgan, DirectorTIME COMPLETED:
03:00 PM
NARRATIVE
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On November 7, 2019 at 1:00 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred on 10/10/2019 at Rolling Hills Covenant Church 191609328 located at 2222 Palos Verdes Drive North, Rolling Hills Estate, CA 90274. The El Segundo Child Care Regional Office received the incident report on 10/11/19. Upon arrival, LPA observed proper care and supervision provided by three teachers and one director for five children. All center staff members that were present during today’s inspection had fingerprint clearance and associated to the designated licensed facility number.
During the investigation, information was obtained through the following:
*Observation of the site where the incident took place
*Interviews of three staff members with written declaration
*Telephone interview of the mother of the child involved in the incident
* Doctor’s Note and certificate to return to school
The investigation revealed that there was no sign of physical hazard in the classroom that contributed to the incident. It happened during dismissal time and the child involved was the last one picked up from the classroom. Per written declaration from staff members, the child was sitting on a circle rug and not engaged in any physical activity with other children. During telephone interview with the mother of the child, she declared that it was an accident. Per physician’s note, there was no fracture in the right arm.

At this time, based on the available information, the incident does not appear to be due to Title 22 violation for lack of care and supervision.
The content of this report was read and discussed in detail with Ensley Morgan, preschool director.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.

SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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