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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192000284
Report Date: 12/18/2023
Date Signed: 12/18/2023 12:58:40 PM


Document Has Been Signed on 12/18/2023 12:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:IGLESIA BAUTISTA/FRIENDSHIP CHILDREN'S CENTERFACILITY NUMBER:
192000284
ADMINISTRATOR:NAOMI LOPEZFACILITY TYPE:
850
ADDRESS:931 FRIGATE AVENUETELEPHONE:
(310) 518-8854
CITY:WILMINGTONSTATE: CAZIP CODE:
90744
CAPACITY:130CENSUS: 39DATE:
12/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Site Director, Naomi LopezTIME COMPLETED:
01:15 PM
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On 12/18/2023 at 10:30 am, Licensing Program Analyst (LPA) Sarah Garcia conducted an unannounced case management visit. Upon arrival, LPA Garcia met with administrator assistant, Vaness and teacher, Nicole. LPA informed them about the purpose of the visit and was granted entry into the facility. LPA observed 39 children with 10 staff. LPA toured the facility. At 11:51am, the site director, Naomi Lopez arrived and met with LPA. LPA informed director about the purpose of the visit.

The purpose of today's visit is to follow-up on a self- reported unusual Incident (LIC 624) reported to Community Care Licensing on 12/04/2023. Information was received that a child was climbing up the outdoor climbing structure and missed the bottom step and fell on the right side of face, falling forward.

LPA Garcia conducted interviews with staff, children, and received the following documents: children’s roster, personnel roster, parent incident notification, LIC 624, medical report, and witness statements. LPA took photographs of the playground apparatus. Based on the information that was gathered through interviews, record reviews, and visual inspection of the playground apparatus (site of the incident), it revealed the child was supervised by a teacher at the time of the incident on 12/04/2023. The preponderance of evidence to prove there was a lack of supervision violation has not been met.

Exit interview was conducted and a copy of the report was provided to director, Naomi Lopez. Appeal rights were reviewed and provided. Notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Sarah GarciaTELEPHONE: (424) 301-3066
LICENSING EVALUATOR SIGNATURE:
DATE: 12/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2023
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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