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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191806528
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:07:06 AM


Document Has Been Signed on 09/14/2023 10:07 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:CHILDREN'S HOSPITAL CHILD DEVELOPMENT CENTER (PS)FACILITY NUMBER:
191806528
ADMINISTRATOR:LAURA HERNANDEZFACILITY TYPE:
850
ADDRESS:4601 SUNSET BOULEVARDTELEPHONE:
(323) 361-4601
CITY:LOS ANGELESSTATE: CAZIP CODE:
90027
CAPACITY:89CENSUS: 19DATE:
09/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Lashawnda Keys, Site SupervisorTIME COMPLETED:
10:30 AM
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On September 14, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced Case Management Inspection at the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Site Supervisor, Lashawnda Keys who guided LPA on a tour of the facility. The purpose of the inspection is to follow up on an unusual incident that occurred on 08/17/2023. The unusual incident was reported timely to the department. LPA observed 19 children in care.

Brief Summary: On 08/17/2023, Child #1 (C1) opened the classroom door and was found in the enclosed common area of the facility for a few minutes (unsure of exact time). Staff #1 (S1) heard the door open and realized C1 had walked out. Staff #2 (S2) brought C1 back into the classroom. Site supervisor spoke with S1 and notified Parent #1 (P1) of incident.

During the inspection, LPA obtained a copy of facility roster and interviewed S1 and Site Supervisor.

There are no deficiencies being given at this time as further investigation is required.

An exit interview was conducted and a copy of this report along with Notice of Site Visit was provided to Site Supervisor, Lashawnda Keys.
SUPERVISOR'S NAME: Ana ChicoTELEPHONE: (323) 981-3374
LICENSING EVALUATOR NAME: Monique Jessica AyalaTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2023
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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