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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197400783
Report Date: 05/12/2023
Date Signed: 05/12/2023 12:34:20 PM


Document Has Been Signed on 05/12/2023 12:34 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:CCRC HEAD START - WOODMANFACILITY NUMBER:
197400783
ADMINISTRATOR:HEATHER STRAUSSFACILITY TYPE:
850
ADDRESS:5944/5939/WOODMAN/BUFFALO AVE.TELEPHONE:
(818) 989-2379
CITY:VAN NUYSSTATE: CAZIP CODE:
91401
CAPACITY:120CENSUS: 45DATE:
05/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Siranush AndakyanTIME COMPLETED:
12:27 PM
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On May 12, 2023 at 9:00a.m. Licensing Program Analyst( LPA) Doris Whitmore conducted an unannounced visit to the facility to conduct a Case Management on an incident that occurred on 04/21/2023. Upon arrival, LPA met with Siranush Andakyan, Center Director and informed the nature of the visit. There was a total of 45 children being supervised by 11 staff.

The El Segundo Regional Office received an phone call from Early Childhood Site Supervisor Heather Strauss at 11:30A.M.that child #1 were in a circle and stepped out of the circle and lost his balance. Child#1 hit the left side of his head (above the ear) on the edge of the wall and received a small cut.

LPA obtained a copy of the facility roster, copy of UIR that was submitted to the office, Ouch Report, CCRC Confidential Medical Referral/ Follow Up Form. LPA reviewed child#1 file and conducted interviews with the staff #1, #2, and Child#1,2,3, and 4. At the time of the incident that occurred, teacher to child ratios were within compliance. Facility staff provided Care and Supervision during the time of the incident.

Based on the information obtained throughout the course of the investigation, there are no deficiencies. An exit interview was conducted with the Center Director Siranush Andakyan and a copy of this report along with the Notice of Site Visit was issued.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2023
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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