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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197407865
Report Date: 07/17/2019
Date Signed: 07/17/2019 01:31:32 PM

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:PLAYHOUSE PRESCHOOL KINDERGARTENFACILITY NUMBER:
197407865
ADMINISTRATOR:SHIRANI PERERAFACILITY TYPE:
850
ADDRESS:526 SOUTH IRENATELEPHONE:
(310) 316-8449
CITY:REDONDO BEACHSTATE: CAZIP CODE:
90277
CAPACITY:45CENSUS: 30DATE:
07/17/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:23 PM
MET WITH:Shirani Perera - LicenseeTIME COMPLETED:
01:45 PM
NARRATIVE
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On 7/17/19, Licensing Program Analyst (LPA) Helen Estrella conducted an unannounced case management visit. Upon arrival, LPA met with the licensee Shirani Perera. LPA informed the nature of the visit. There was a total census of 30 children being supervised by 5 staff and the Director.

The Department became aware of the Unusual Incident/Injury on 6/26/19 over the course of a complaint investigation. During today’s visit, it was disclosed by the licensee that child #1 obtained an injury in the facility. The licensee states that on 6/19/19 child #1 was running in the outdoor play yard when she observed him trip and fall forward. This resulted in child #1 chipping his front tooth. The parents were notified at arrival to the facility. The following day, the licensee was informed by the parents that medical attention was provided to the child and it was made aware the child’s tooth was broken.

The content of this report was read and discussed in detail with the licensee. The facility is not operating within substantial compliance per Title 22 regulations and Type B deficiencies will be cited today 7/17/19.

An exit interview was conducted, a copy of this report and notice of site visit provided to the licensee.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: PLAYHOUSE PRESCHOOL KINDERGARTEN
FACILITY NUMBER: 197407865
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/17/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2019
Section Cited
CCR
101212(d)(1)(C)
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Reporting Requirements: Upon the occurrence, during the operation of the child care center of any incident, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours for any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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Licensee will submit a written plan of correction no later than the end of business day on 717/19, explaining how she plans to adhere to Title 22
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This requirement is not met as evidenced by Licensee disclosed that she did not report an incident report that happened on 6/19/19.
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regulations and report all serious unusual incident/injury reports to the Department no later than 7/24/19.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2019
LIC809 (FAS) - (06/04)
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