191803046-5-17-2023-33-CC-MJAA-CRWNR8-20230517104107

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191803046
Report Date: 05/17/2023
Date Signed: 05/17/2023 10:43:55 AM

Document Has Been Signed on 05/17/2023 10:43 AM - It Cannot Be Edited

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 SCHOOL		FACILITY NUMBER:	191803046
ADMINISTRATOR:	LISSETT AVILA		FACILITY TYPE:	850
ADDRESS:	2646 GRIFFITH PARK BOULEVARD		TELEPHONE:	(323) 663-8049
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90039
CAPACITY:	92	CENSUS: 42	DATE:	05/17/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Lissett Avila, Director		TIME COMPLETED:	11:00 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On May 17, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management inspection for the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with director, Lissett Avila who guided LPA on a tour of the facility. The purpose of the inspection is to follow up on an incident that occurred on 05/12/2023 and was reported to the department by the next business day (05/15/2023). LPA observed 42 children in care with 8 staff members. Brief Summary: Child #1 (C1) was playing and jumping up and down when he landed on his knees. C1 used his elbows to hold his face up from the ground. C1 landed on the padded area near the tree house patio. C1 started crying loudly. Staff #1 (S1) checked surrounding area where C1 fell to figure out what was wrong before picking up C1 carefully. Staff #2 (S2) assisted C1 to lay on a cot and provided an ice pack. S2 stayed with C1 until C1's grandmother picked him up. C1 was taken to the emergency room. C1 was placed in a cast for breaking his left leg. During the inspection, LPA obtained a copy of the facility roster, obtained a copy of sign in sheet, obtained images of where C1 fell, interviewed Parent #1 (P1), S1 and S2. LPA interviewed S1 who stated that she was 2 to 3 feet away from C1 when the incident occurred. Per S1 she observed the incident and was unable to prevent the incident from happening. S2 stated that there were 10 children in care on the day of the incident; LPA verified there were 10 children in attendance per sign in sheet. Per S1, C1 was jumping up and down and C1 jumped, landed on his knees and elbows. Per S1 when C1 fell, C1 started to cry and S1 went over to C1 to assess the situation. S2 assisted C1 by bringing him into the office and placed C1 on a cot. Per S1, she called P1 to notify P1 of the incident. Per S1 and S2 there was enough supervision (10 children with 2 teachers), the padding material is sufficient and the incident could not have been prevented. LPA observed padding material where C1 fell. Per P1, C1 broke the left leg and is now in cast. Per P1, the facility had proper supervision, the padding is sufficient and the facility handled the situation properly. Per S1, S2 and P1, C1 was given an ice pack.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 SCHOOL	FACILITY NUMBER: 191803046
	VISIT DATE: 05/17/2023

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There are no deficiencies being cited as this was an incident that occurred fast and was unable to be prevented. Per S1 she witnessed the incident occur and took the proper measures to ensure C1 received the proper first aid care.

LPA observed the cushioned material (padding) to be in good repair, LPA observed sign in sheets for children on the day of incident and found the facility to be in ratio. This incident was an accident.

An exit interview was conducted and a copy of this report was provided to director along with Notice of Site Visit.

SUPERVISOR'S NAME: Ana Chico	TELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica Ayala	TELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2023

LIC809 (FAS) - (06/04)

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