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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871609
Report Date: 01/22/2020
Date Signed: 01/22/2020 02:13:03 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 CENTERFACILITY NUMBER:
191871609
ADMINISTRATOR:CATHERINE HILLIARDFACILITY TYPE:
850
ADDRESS:4000 SO. LA BREA AVE.TELEPHONE:
(323) 291-5929
CITY:LOS ANGELESSTATE: CAZIP CODE:
90008
CAPACITY:45CENSUS: DATE:
01/22/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Catherine Hilliard (Director)TIME COMPLETED:
01:00 PM
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On 1/22/2020 @ 12:00 pm, Licensing Program Analyst (LPA’s) Lourdes Castellanos and Ericka Hill conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred at Jim Gilliam Child Care Center on 12/19/19. The El Segundo Regional Office received the incident report on 12/20/19. LPAs met with Caterine Hilliard , Director. LPAs observed 7 Children in the Gold room (3 year old classroom) present with 2 teachers .

The report stated that on 12/19/19 , Witness #1 observed Teacher/Staff #1 (Celia Gomez) pulling on the ear of Child #1 during the holiday event because Child #1 would not sit still. The Director stated that Witness #1 and the mother of Child #1 both spoke with the Director about the incident with Child #1 and S1. During the interview with S1, S1 stated that the mother of Child #1 spoke with S1 about the incident and the Director. S1 further stated that after the mother of Child #1 spoke with both the Director and S1, the mother of Child #1 stated for S1 "to not worry about it".

LPA's observed the daily operation of the facility, conducted interviews with the Director, S1, and Child #1 regarding the incident. Based on the information obtained during observation and interviews, with the self reported Unusual Incident/Injury Report, it was determined that S1 did not violate the personal rights of Child #1 and that Child #1 was not mishandled by S1.

No deficiencies were observed during the visit.

An exit interview was conducted and a copy of this report, and a Notice of Site Visit were provided to Catherine Hilliard Director.

SUPERVISOR'S NAME: Victor BautistaTELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Lourdes CastellanosTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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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