191802038-10-25-2019-54-CC-AJLO-BHAN9A-20191025101536

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802038
Report Date: 10/25/2019
Date Signed: 10/25/2019 10:15:41 AM

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:	HOOVER INTERGENERATIONAL CARE, INC. (CHILD DEV CTR		FACILITY NUMBER:	191802038
ADMINISTRATOR:	KRISTEN ZEERBAUGH		FACILITY TYPE:	850
ADDRESS:	3216 S. HOOVER ST		TELEPHONE:	(213) 748-3700
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90007
CAPACITY:	69	CENSUS: 52	DATE:	10/25/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kristen Zearbaugh, Director		TIME COMPLETED:	10:25 AM

NARRATIVE

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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) A. Lucero to address an Unusual Incident Report that was received in the licensing office on 7/15/2019. LPA met with Director Kristen Zearbaugh who guided LPA on a tour of facility of both indoors and outdoors.

On 7/15/19, child #1 was playing on the outside playground and fell, landing on their elbow. First aid was given to the child and child's authorized representative was contacted. Child was taken to see a physician by their representative and returned with restrictions. LPA obtained a copy of ouch report and two doctor's notes.

Based on all information obtained on this date, and interviews conducted, no follow-up may be 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.

There were no deficiencies cited during today's visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty.

Exit interview, copy of report was given. Appeal rights were issued and discussed.

SUPERVISOR'S NAME: Brandi VanOosten	TELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Armando J Lucero	TELEPHONE: (323) 981-3435
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2019

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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