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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197410716
Report Date: 04/30/2019
Date Signed: 04/30/2019 11:49:19 AM

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:WEST LOS ANGELES COLLEGE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197410716
ADMINISTRATOR:KELLEY, KATYFACILITY TYPE:
850
ADDRESS:9000 OVERLAND AVENUETELEPHONE:
(310) 287-4357
CITY:CULVER CITYSTATE: CAZIP CODE:
90230
CAPACITY:72CENSUS: DATE:
04/30/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Katy Kelley, DirectorTIME COMPLETED:
11:45 AM
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On 04/30/2019 at 10:38am, Licensing Program Analyst (LPA) Denise Miranda, conducted an unannounced case management – incident visit to the facility to deliver the findings of the incident that was self reported by the facility and occurred on 4/8/2019. LPA met with Katy Kelley, center director, and discussed the purpose of the visit. There was a total census of 45 children and 3 Teachers and 10 teacher assistants present during today's visit


According to the report received, on 4/8/2019, a child’s mother showed to the staff (Angelina Gomez) a wound on base of child’s#1 back. Child’s mother said that occurred when child#1 was with his dad on the weekend. Also, Child’s mother said that while child#1 was with his dad, child#1 disclosed that during day care hours, another child had kissed on his face and his private areas. Child’s mother said that “she did not believe it, in that he was retaliation for her filing a complainant against his step daughter.

At this time based on the available information, it does not appear that this incident was the result of title 22 violation; therefore no additional action is required and no deficiency will be cited.

An exit interview was conducted, and a copy of this report was provided to Katy Kelley, Director.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2019
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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