191871609-2-19-2020-30-CC-LCAS-BLXU95-20200219142235

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191871609
Report Date: 02/19/2020
Date Signed: 02/19/2020 02:22:43 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:	JIM GILLIAM CHILD CARE CENTER		FACILITY NUMBER:	191871609
ADMINISTRATOR:	CATHERINE HILLIARD		FACILITY TYPE:	850
ADDRESS:	4000 SO. LA BREA AVE.		TELEPHONE:	(323) 291-5929
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90008
CAPACITY:	45	CENSUS: 20	DATE:	02/19/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Cathy Hilliard		TIME COMPLETED:	01:30 PM

NARRATIVE

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On 02/19/202 @ 11:30 am , Licensing Program Analyst (LPAs) Lourdes Castellanos conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred at Jim Gilliam CCC on 01/07/2020. The El Segundo Regional Office received the incident report on 01/24/2020. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number. LPA met with Cathy Hilliand, Child Care Director, LPAs observed 10 Children in the Gold room (3 year old classroom) present with 3 Staff and 10 children in the Blue room with 3 staff.

According to the report, on 01/24/2020, C1 slipped and fell from a swing and hit his mouth on the mat under the swing in the center’s play area.
During this inspection, LPA conducted interviews with facility staff and inspect the playground area.

Director stated that C1 fell from a swing in the center’s play area on 1/07/2020 at approx. 1pm. C1 hit his mouth on the mat and noticed bleeding from his mouth. S1 washed the blood out of his mouth and applied ine and began first aid. C1 parent was contacted and took C1 home. On 1/13/2020 parent notified Director that C1 had to see a specialist. C1 returned to the facility on the 1/15/2020. At the time of incident there were 12 children and 3 staff. Facility was in ratio. Staff /children roster was reviewed, and copies were provide to LPA.

LPA’s toured the facility including the playground where the injury happened. During the visit at 12:00 pm, LPA inspected the structure (Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness). LPA Castellanos took photos and inspected the play area. There are no visible signs that there are any defects to the play structure, it appears to be sound and in good condition. LPA observed the structure itself is appropriate for children ages 2 to 5 years old. Underneath the structure is resilient rubber cushioning which also appears to be sound and in good repair.

{continued on LIC 809-C}

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

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: JIM GILLIAM CHILD CARE CENTER	FACILITY NUMBER: 191871609
	VISIT DATE: 02/19/2020

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Based on the information gathered throughout the course of this investigation. It does not appear this incident was the result of a title 22 violation for personal rights/lack of supervision. 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 injury. At this time no citation will be issued for the incident which occurred on 01/07/2020. The facility followed proper emergency protocol. Parent was properly informed, and the facility submitted a timely incident report.

An exit interview was conducted and a copy of this report, appeal rights and a Notice of Site Visit were provided to Cathy Hilliar, Child Care Director .

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Lourdes Castellanos	TELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:	DATE: 02/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2020

LIC809 (FAS) - (06/04)

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