<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409567
Report Date: 08/05/2021
Date Signed: 08/05/2021 03:05:21 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:CHILDREN OF OUR SAVIOR PRE-SCHOOLFACILITY NUMBER:
197409567
ADMINISTRATOR:CHARSHA, BEVERLYFACILITY TYPE:
850
ADDRESS:6705 W. 77TH STREETTELEPHONE:
(310) 215-3166
CITY:WESTCHESTERSTATE: CAZIP CODE:
90045
CAPACITY:144CENSUS: DATE:
08/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Director Beverly CharshaTIME COMPLETED:
03:30 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 August 5th, 2021, Licensing Program Analyst Lisa Rios went to the Children of Our Savior Pre-school to conduct a case management inspection regarding an unusual incident that was reported to the RO (see LIC812 titled Incident Report dated 7/30/21). On July 28th, 2021, at approximately 9:05 am, a child suffered a hairline fracture going down a water slide.

Through interviews with staff, it was determined that the slide was unsafe as it was not filled yet in a reservoir of water at the bottom of the slide meant to keep children from hitting the bottom hard as the slide was on asphalt.

See LIC812 dated 7/28/21 showing a photo of the slide.

The facility will be cited a type A citation today (see LIC809D).

A copy of the report, appeal rights and Notice of Site visit were issued to the Director.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CHILDREN OF OUR SAVIOR PRE-SCHOOL
FACILITY NUMBER: 197409567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2021
Section Cited

1
2
3
4
5
6
7
101239
Fixtures, Furniture, Equipment and Supplies
(1) Equipment shall be maintained in a safe condition....
This requirement is not met as evidenced by.....
8
9
10
11
12
13
14
Base on interviews and documents received, the waterslide was not safe for children to go down as the reservoir where children land at the bottom had not yet been filled with water.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Lisa RiosTELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2021
LIC809 (FAS) - (06/04)
Page: 2 of 2