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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192005252
Report Date: 05/13/2019
Date Signed: 05/13/2019 03:24:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:TODD FAMILY CHILD CAREFACILITY NUMBER:
192005252
ADMINISTRATOR:TODD, LORNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 438-3004
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:14CENSUS: 11DATE:
05/13/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:LicenseeTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA), Tiffanie Tran arrived at the above facility to conduct a case management incident inspection. Licensee had made a self-reported unusual incident that occurred on 04/03/19, where a child had hospitalized due to seizures. Upon arrival, LPA met with licensee, licensee's adult daughters with 11 child care children. Children were observed napping on cot with blanket covered.

Per licensee stated, on 04/03/19 about 4:22PM licensee observed C1 fell on the floor and started having seizures. Licensee's immediately had adult daughter call 911 and child's parent. While on the 911 call, paramedic provided verbal instruction to licensee. About five minutes paramedic arrived, and soon after parent came. Parent followed the paramedic to the hospital. Parent kept child home for three days. Upon returned, parent disclosed to licensee that doctor stated child had cabral seizure to triggered the seizures.
LPA reviewed child's records and reviews child had no medical history for seizures. LPA obtained child's document.

LPA discussed Incidental Medical Services (IMS) with licensee. Per licensee, the facility is currently does not service children that required IMS.

At this time, no deficiencies were observed or cited. Based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2019
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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