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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871609
Report Date: 10/03/2019
Date Signed: 10/03/2019 12:43:11 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: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: 22DATE:
10/03/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jacqueline SumpterTIME COMPLETED:
01:00 PM
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On 10/3/19, Licensing Program Analyst (LPA) Karren Starks made an unannounced visit for the purpose of conducting a Case Management Inspection to inspect and measure the new playground that was upgraded.

LPA met with Lead Teacher, Jacqueline Sumpter due to the Director being away at a training session.

LPA inspected and measured the gated playground area observing a large climbing apparatus with slides and proper cushioning, two sitting areas and several manipulative stations as well as swings at the far end of the yard. There is still a sitting/shade area adjacent to the facility as well as a drinking fountain and sink for hand-washing.

LPA advised the Lead Teacher that additional supervision is needed for the apparatus due to the open areas.

The measurements for the playground are:

106.416 X 67.33 = 7164.989 minus 222.18 = 7387.169 divided by 75 for a Total of 98.49. The outdoor space is still able to accommodate the licensed capacity.

Management review is required prior to resuming use of the licensed playground and the facility must provide LPA with documentation showing the age range usage of the installed apparatus and adhere the age range decals.

Copy of report and Notice of Site Visit are being issued.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2019
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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