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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191870909
Report Date: 11/19/2019
Date Signed: 11/19/2019 10:53:25 AM

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:WESTMINSTER AVENUE EARLY EDUCATION CENTERFACILITY NUMBER:
191870909
ADMINISTRATOR:SCRUGGS, LIZAFACILITY TYPE:
850
ADDRESS:1010 MAIN ST.TELEPHONE:
(310) 392-4581
CITY:VENICESTATE: CAZIP CODE:
90291
CAPACITY:117CENSUS: 65DATE:
11/19/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Ricky Lim PrincipalTIME COMPLETED:
10:55 AM
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On 11/19/2019 8:45am, Licensing Program Analyst (LPAs) Denise Miranda arrived at Westminster Avenue Early Education Center for the purpose of following up on the unusual incident that occurred at the facility on 11/4/2019. The unusual incident was reported via phone call and by writing on 11/5/2019.LPA met with Ricky Lim, Principal and discussed the purpose of the visit.

According to the Unusual Incident Report (UIR), on 11/4/2019 at 4:15pm, during outdoor play time, child#1 jumped onto a sofa located at the reading area during outside time. Child#1 slipped, fell and hit her head on the ground.

LPA obtained copy of children's and staff sign in and out. Also, LPA obtained a photo of the outdoor area, the location that incident happened on 11/4/19.

LPA concluded that at the time of the incident there was adequate supervision and no hazards were found in the playground that may have contributed to the child’s fall. The facility followed proper emergency protocol. As a plan of action, Principal and Staff rearranged the reading area by relocating all the sofas from the reading area to be leaning against to the walls in the effort to prevent any future incident. Principal had a conversation with staff that shall engage with children in conversations and discussing clear outdoor expectations for sofa outdoor play. No deficiency shall be cited today.


An exit interview was conducted, and a copy of this report was provided to Ricky Lim, Principal and a copy of this report will be mail to the facility's mailing address.

SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2019
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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