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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871609
Report Date: 02/19/2020
Date Signed: 02/19/2020 02:23:26 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: 20DATE:
02/19/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Cathy Hilliard Director TIME COMPLETED:
02:30 PM
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On 02/19/202 @ 1:30 pm , 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 11/06/19. The El Segundo Regional Office received the incident report on 11/19/2019. 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 Hilliard, Director. LPA observed 10 Children in the Gold room (3 year old classroom) present with 2 teachers, and 10 children, 3 staff in the Blue room. .

According to the report, on 11/06/19, C1 and C2 were fighting over a place in line. C1 scratched C2 on both sides of his face.

Based on the information that were gathered through the course of interview and observation, it revealed that on the day of the incident there were 3 staff with 10 children in the Gold room. S1 observed children were fighting for a place in line. C1 scratched C2 in the face. S1 cleaned C2 face with soap and water. Director contacted C1 mother and asked her to come to the center and discuss the and C1 behavior. Per C1 mother she has witnesses C1 has the same behavior with family members at home. Parents and Director will continue to observe, document and monitor C1 behavior. C2 mother was contact and was provide an incident report. LPA concluded that at the time of the incident there was adequate supervision. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

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

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