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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411136
Report Date: 12/06/2019
Date Signed: 12/06/2019 03:13:50 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:FUTURE STARS CHILDREN'S ACADEMYFACILITY NUMBER:
197411136
ADMINISTRATOR:SARAH HAWKINSFACILITY TYPE:
830
ADDRESS:2320 PACIFIC COAST HIGHWAYTELEPHONE:
(310) 530-0256
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:32CENSUS: DATE:
12/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sarah Hawkins, DirectorTIME 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 December 6, 2019 at 12:00 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred on 10/23/2019 at Future Stars Children’s Academy 1974111 36 located at 2320 Pacific Coast Highway, Lomita, CA 90717. The El Segundo Regional Office received the incident report on 10/24/19. Upon arrival, LPA observed 23 children in the classroom being supervised by seven adults.
Based on the information that were gathered through visual observation of the chairs and site where incident occurred and interviews conducted with three staff members (written declarations obtained), it revealed that, on the day of the incident, that there were 12 children and three teachers in the classroom. When C1 attempted to climb the stack of chairs located in the classroom, one of the teachers who was approximately five feet from the child approached to redirect the child away from stacked the chairs. According to the report, as the child attempted to climb the stacked chairs, the child fell backwards, and a chair fell from the stack and hit the child in his left eyebrow. The child sustained a cut and teacher immediately applied pressure to stop the bleeding.
Parent took the child to the emergency room and the child received two stitches. The child returned to school the next day, 10/24/19, without restrictions.
To avoid future incidents, the director purchased a cabinet and placed stacked chairs inside with a latch to secure the cabinet from being accessible to children in care.
LPA Cohen obtained the following: Written declaration from the teachers and the director, Facility Roster, Sign In/Out, Teacher Time Sheets, and Medical Information.
At this time based on the available information, it does not appear that this incident was the result of a Title 22 violation for lack of care and supervision.
The content of this report was read and discussed in detail at the time of inspection with preschool director, Sarah Hawkins. An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2019
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 1