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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191610282
Report Date: 09/28/2023
Date Signed: 09/28/2023 05:22:52 PM


Document Has Been Signed on 09/28/2023 05:22 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: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: 15DATE:
09/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jennifer Murillo, Center CoordinatorTIME COMPLETED:
04:11 PM
NARRATIVE
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Licensing Program Analyst (LPA) V. Wheatley conducted an unannounced case management inspection on 9/28/2023 and met with Center Coordinator Jennifer Murillo regarding an unusual incident report which was submitted to the Department on 8/9/2023 regarding a child that was fed the wrong milk. The child was served breast milk by mistake. The parents were contacted immediately.

LPA toured the entire facility and observed children supervised within proper ratios. LPA inspected the kitchen in the infant room whereby the incident occurred. LPA observed 6 infants in care with 3 staff members and one student worker. LPA observed baby bottles properly labeled and refrigerated.

LPA interviewed staff regarding the incident. Based on information obtained and interviews which were conducted, the incorrect bottle was given to the other child by mistake. The child did not have an allergic reaction. The staff have enhanced their new plan by verbalizing who they are feeding to ensure that this does not happen again. See LIC 809D. This is a Type A violation. A copy of this report will be provided to parent.

Exit interview. A copy of the report will be provided to the parents.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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 09/28/2023 05:22 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: FERNALD CHILD CARE CENTER - INFANTS
FACILITY NUMBER: 191610282

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/29/2023
Section Cited
CCR
101223(a)(2)

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101223 (a)(2) Personal Rights - The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The Center Coordinator will ensure that children enrolled in the program are provided the correct milk and food. The staff have enhanced their new plan by verbalizing who they are feeding to ensure that this does not happen again. A meeting with all staff will be conducted and the staff will sign a declaration stating they understand the new protocol and will adhere to it.
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This deficiency is evidenced by:

Staff #1 fed Child #1 the wrong bottle which was breast milk. This is an immediate risk to the health and safety in care.
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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: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Veronica WheatleyTELEPHONE: (424) 301-3051
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
LIC809 (FAS) - (06/04)
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