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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405506
Report Date: 02/01/2023
Date Signed: 02/01/2023 11:05:55 AM


Document Has Been Signed on 02/01/2023 11:05 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CREATIVE KIDSFACILITY NUMBER:
197405506
ADMINISTRATOR:BRITTLYN WHITEFACILITY TYPE:
850
ADDRESS:1203 N. SEPULVEDA BLVD.TELEPHONE:
(310) 546-6540
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:117CENSUS: 85DATE:
02/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:BRITTLYN WHITE, DIRECTORTIME COMPLETED:
11:15 AM
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On 2/1/2023, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 1/25/2023. LPA was greeted by Director, Brittlyn White, toured the facility and took a census of the children. Upon arrival, there were 85 children and 19 staff present today at the facility for the Preschool.

Description of the incident: On 1/24/2023 at approximately 11:00am during outdoor playtime. C1 was climbing the stairs of a small slide. C1 stepped on second step and lost his balance and fell off. S1 went to help and comfort C1. A short time later S2 noticed C1 was not playing and favoring his right arm. S2 reported the incident to Director and parent was called. Parent arrived and took C1 to the Doctor. The parents were told that C1 broke his arm and had surgery on 1/25/2023.

During this inspection, LPA toured the facility, interviewed staff, obtained a copy of the facility roster, inspected the outdoor area and play equipment where incident happened.

Based on the information provided and interviews conducted the incident will require further investigation.

An exit interview was conducted, a copy of this report and notice of site visit was provided to Director.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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