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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610282
Report Date: 01/09/2020
Date Signed: 01/09/2020 03:05:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FERNALD CHILD CARE CENTER - INFANTSFACILITY NUMBER:
191610282
ADMINISTRATOR:ALICIA MINOR BROWNFACILITY TYPE:
830
ADDRESS:10620 SUNSET BLVD.TELEPHONE:
(310) 825-2900
CITY:LOS ANGELESSTATE: CAZIP CODE:
90095
CAPACITY:26CENSUS: 9DATE:
01/09/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alicia Minor Brown, Center DirectorTIME COMPLETED:
03:00 PM
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On 01/09/2020 at 09:30 am, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Fernald Child Care Center-Infants for the purpose of following up on the self reported unusual incident that occurred at the facility on 12/18/2019. The report was received by the El Segundo Regional Child Care Office via telephone call on 12/18/2019 and the LIC 624 (Unusual Incident/Injury Report) was received on 12/24/2019.

According to the report, on 12/18/2019, Wednesday, approximately 07:45 am in the Pink Room, child was in a standing position while holding onto the blue riser on the floor near the meal table and adjacent to the cabinets. Staff#1 was walking towards the child after a retrieving a ball child has tossed out of the riser. The child turned body to the right and let go of the riser. The child attempted to free stand and let go of the riser, as a result, the child lost balance and fell backwards. The child hit the left side of head on the cabinet as child fell. The child began to cry while trying to gasp for air. Staff#1 realized child was not catching breath as child continued to cry. Child took a deep breath and passed out. Staff#1 tried to get the child to respond while staff#2 called 911. The paramedics transported the child and parent to UCLA Medical Hospital for further assessment. The parent notified the school two hours later that no treatment was needed and child was cleared to return to school on 12/19/2019.

During this inspection, LPA conducted an interview with facility staff, child's parent, reviewed records and obtained documents. LPA also toured the infant classroom and inspected the apparatus child was on and observed cushioning material underneath the riser. Based on information obtained throughout the course of the investigation, it was revealed that on the day of the incident, the child's parents were immediately notified and sought medical assistance on the day of the incident. The child remains enrolled in the above day care. Both teachers and child’s parent statements were consistent. LPA concluded that that at the time of the incident there was adequate supervision and no hazards were found in the classroom that may have contributed to the child’s fall. The facility followed proper emergency protocol. No deficiency shall be cited. An exit interview was conducted and a copy of this report was provided to Alicia Minor Brown, Center Director
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2020
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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