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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192006309
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:00:38 PM


Document Has Been Signed on 04/27/2022 03:00 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:ALEGRIA AFTER SCHOOL PROGRAMFACILITY NUMBER:
192006309
ADMINISTRATOR:VICTORIA REEDFACILITY TYPE:
840
ADDRESS:2737 SUNSET BOULEVARDTELEPHONE:
(323) 454-4200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90026
CAPACITY:21CENSUS: 9DATE:
04/27/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:VICTORIA REEDTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Judy Mora conducted a case management inspection due to an incident that occurred on 03/11/22. LPA met with Site Supervisor, Victoria Reed. At the time of arrival there were no children and staff present. Staff were out picking up children. LPA waited for staff and children to return to the facility. LPA was guided on a tour of the facility at approximately 2:40 PM.

On 03/11/22 a child had an accident on the outdoor playground. The child was injured and medical attention was needed. The child jumped up in an attempt to tap an area on the apparatus. The child fell onto the ground landing on his right elbow. First aid was administered and parent was notified. The child sustained a lateral epicondyle fracture. Child is currently in a cast. The child is currently in attendance at the facility and returned on 03/14/22.

LPA conducted interview with child. The staff who was present when the injury occurred was not present during this inspection. LPA Mora also visually inspected the area where the incident occurred and photo was obtained.

Based on all information obtained on this date, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Victoria Reed, Site Supervisor.
SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) 981-3417
LICENSING EVALUATOR NAME: Judy MoraTELEPHONE: (323) 896-6847
LICENSING EVALUATOR SIGNATURE:
DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/27/2022
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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