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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191803046
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:48:16 PM


Document Has Been Signed on 07/11/2023 01:48 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
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: 48DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lissett Avila, DirectorTIME COMPLETED:
02:00 PM
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On July 11, 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 07/07/2023 and was reported to the department by the same business day (07/07/2023). LPA observed 48 children in care with 12 staff members.

Brief Summary: At approximately 9:30am, Child #1 (C1) was climbing the plastic play structure in the lower yard. C1 fell off as he was climbing down and landed on his left leg/foot. C1 started to cry and was unable to get up. The Staff #1 (S1) carried him over to the rug area to assess injuries. S1 called C1's father who arrived within 30 minutes. C1 was taken to seek medical attention and sustained a Type 1 fracture to his tiba.

During the inspection, LPA interviewed S1 and reviewed sign in sheets for the day the incident occurred for children that were present in C1's classroom. LPA observed an incident report that was not provided to C1's father due to the family leaving to take C1 to seek medical attention. Based on interviews, S1 stated the class was starting to line up to return into the classroom when she asked C1 to start lining up. S1 stated she observed C1 climbing out of the plastic play structure that is located in the sandbox. S1 stated that C1 slipped and landed on his left leg/foot. S1 stated that C1 was unable to stand on his leg and was crying. S1 stated she called Parent #1 (P1) who came to pick up C1 within 30 minutes. LPA called C1's parents, there was no answer; LPA left a voicemail with call back information. LPA observed the sandbox area with adequate sand, cushioning and age appropriate. This was an accident that occurred fast and was unable to be prevented.

An exit interview was conducted and copy of this report was provided to the director along with Notice of Site Visit.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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