197408577-7-6-2023-30-CC-DWHE-CTGTY2-20230706150802

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408577
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:08:06 PM

Document Has Been Signed on 07/06/2023 03:08 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:	SANTA MONICA-MALIBU USD/WASHINGTON WEST H.S./S.P.		FACILITY NUMBER:	197408577
ADMINISTRATOR:	ALICE CHUNG		FACILITY TYPE:	850
ADDRESS:	2802 4TH STREET, ROOM 2		TELEPHONE:	(310) 399-5865
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	71	CENSUS: 12	DATE:	07/06/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Reham Dabash - Assistant Director		TIME COMPLETED:	03:07 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On July 6, 2023, at 1:30 p.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 06/22/2023. Upon arrival, LPA met with Reham Dabash, Assistant Center and informed the nature of the visit. There was a total of 12 children being supervised by 3 staff. According to the UIR on 06/22/2023 child went up the steps of the playground structure and missed her step, falling on her knees, hitting her mouth on the edge of the step, Her two front teeth became loose and started to bleed. Child’s lower lip sustained a bruise. LPA interviewed the Assistant Director that child#1 was going up the step and fell down on her knees and when child went forward on her face and teeth. Jennifer the assistant was standing in the area of the play structure and saw what happened? Jennifer the assistant went to the child and then called teacher Claudia. The other teacher was in the bike area. There were a total of three staff on the playground when the incident occurred. The children were on the yard. Teacher Claudia called the parents. The mother stated she was further out and will send the dad. The dad came at 11:40 a.m. and took the child to the dentist. At the time of the incident staff called the Director and Assistant Director. When the child was being cared for Claudia called the mother, Susan, the Director sat with the child, and the Assistant Director covered the classroom. The other two teachers were outside with the children. Assistant Director did an full investigation regarding the incident and checked the playground structure and to conduct a safety check. LPA obtained a copy of the facility roster, copy of UIR that was submitted to the office, Preschool Ouch / First Aid Report, Head Injury Report & Note from the Dentist. LPA reviewed child#1 file and conducted a interview with the Assistant Director. LPA reviewed the dentist note and the instructions that were given. LPA also reviwed the Supervision Checklist and the time that the child left. LPA reviwed the sign in sheet the day the incident occurred.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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: SANTA MONICA-MALIBU USD/WASHINGTON WEST H.S./S.P.	FACILITY NUMBER: 197408577
	VISIT DATE: 07/06/2023

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The child returned back to school the next day 06-22-23. The child was signed in on 06/23/2023 at 8:11 a.m. At the time of the incident that occurred, teacher to child ratios were within compliance. LPA Whitmore viewed the area where the incident occurred and checked that the structure was age appropriate. LPA also checked to make sure that there were no objects or anything that stood out. On the structure there is a sticker that says Ages 2-12.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 Assistant Director ,Reham Dabash and a copy of this report along with the Notice of Site Visit was issued.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris Whitmore	TELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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