191870878-10-8-2019-30-CC-DMIA-BGRRSN-20191008131701

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870878
Report Date: 10/08/2019
Date Signed: 10/08/2019 01:17:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	WILMINTON PARK EARLY EDUCATION CENTER		FACILITY NUMBER:	191870878
ADMINISTRATOR:	UDEOCHU, MERCY		FACILITY TYPE:	850
ADDRESS:	1419 YOUNG ST.		TELEPHONE:	(310) 518-3207
CITY:	WILMINGTON	STATE: CA	ZIP CODE:	90744
CAPACITY:	165	CENSUS: 128	DATE:	10/08/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Nicola Boyken, Director Assistant		TIME COMPLETED:	10:30 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 10/8/2019 at 08:30 am, Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced inspection at Wilmington Park Early Education Center located at 1419 E. Young Street, Wilmington, CA 90744 for the purpose of following up on the self-reported unusual incident that occurred at the facility on 09/06/2019. The Unusual Incident/Injury Report (UIR) was received by the El Segundo Regional Child Care Office on 09/10/2019. Upon arrival, LPA observed a total of 128 children present being supervised by 24 staff members. According to the Unusual Incident/Injury Report (UIR) that the Department received, on 09/06/2019 at 3:25 pm, child#1 was dancing in the music area with two children and tripped on child#2 foot. Child#1 fell and hit the left side of her face on the corner of the bookcase. Child#1 has a small cut near of her left eye. During this inspection, LPA inspected the space where the incident occurred the space was found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. LPA observed the edges of the bookshelf has a rubber as a protection. This agency has investigated the unusual incident which includes observations at the facility, interview with relevant parties, and review of records. During this investigation, it was revealed that on 09/06/2019, there were 2 teachers and 3 staff present in the classroom with 12 children when the incident occurred, and staff observed the incident.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: WILMINTON PARK EARLY EDUCATION CENTER	FACILITY NUMBER: 191870878
	VISIT DATE: 10/08/2019

NARRATIVE

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Based on the information gathered throughout the course of the investigation, it does not appear that the incident was a result of a Title 22 violation. Facility staff acted immediately, and first aid was administered. Child's parents were also immediately notified of the incident. The director conducted a training with staff regarding care and supervision and physical plan. Director and staff that bookshelf that was place to divide the music area mas removed and placed by the wall.

An exit interview was conducted and a copy of this report along with the Notice of Site VIsit were provided to Nicola Boyken, Director Assistant.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2019

LIC809 (FAS) - (06/04)

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