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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191803046
Report Date: 02/04/2020
Date Signed: 02/04/2020 02:59:41 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:LOS ANGELES FAMILY SCHOOLFACILITY NUMBER:
191803046
ADMINISTRATOR:LISSETT AVILAFACILITY TYPE:
850
ADDRESS:2646 GRIFFITH PARK BOULEVARDTELEPHONE:
(323) 663-8049
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY:92CENSUS: 75DATE:
02/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Lissett Avila, DirectorTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Thelma Razo and Crystal Green conducted an unannounced Case Management - Incident inspection to follow up on an incident that was reported to the Department on 1/16/2010 via fax. Licensing staff met with Director Lissett Avila and stated the purpose of the visit. Census is currently 75 preschool children.

An incident was reported to the department which occurred on 1/9/2020 during outdoor PM Recess, Child #1 (C1) was playing with a shovel, C1 threw the shovel up in the air which landed on Child #2 (C2) causing a laceration. A copy of medical report dated 1/9/2020 was attached to the report. The center submitted a written incident report to the Department within 7 days.

During this inspection, Licensing staff observed the outdoor play area where the incident occurred and conducted interview with Director Avila and two staff members. Per Director, immediate medical aid was administered by the staff, C2's parent was notified and together with staff, went to the emergency where C2 received 3 stitches. According to interviews conducted, this is an unusual occurrence and C1 does not have a behavior pattern. LPA observed the plastic shovel has no sharp edges and is age appropriate. Based LPAs' observation of the outdoor play area and interviews conducted, LPA has determined there was adequate supervision provided on the day of the incident. Per California Code of Regulations, Title 22, Division 12, no deficiency was cited during this visit.

Exit interview conducted with Director Lissett Avila and copy of this report provided.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of S100.00.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 513-3793
LICENSING EVALUATOR NAME: Thelma RazoTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2020
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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