197411601-8-13-2019-30-CC-SPOL-BEZRVR-20190813132158

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411601
Report Date: 08/13/2019
Date Signed: 08/13/2019 01:22:55 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:	VOALA /HAWTHORNE EARLY HEAD START		FACILITY NUMBER:	197411601
ADMINISTRATOR:	LENA BLAKENEY		FACILITY TYPE:	830
ADDRESS:	4951 W. 119TH PLACE		TELEPHONE:	(310) 675-0653
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	33	CENSUS: 6	DATE:	08/13/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Isabel Vitela, Site Supervisor		TIME COMPLETED:	01:54 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	Licensing Program Analyst (LPA), Shandra Powell, conducted a Case Management visit to follow up on the self reported incident that occurred on 08/02/2019 (Friday). The facility contacted the El Segundo Regional Child Care Licensing Department via telephone on 08/05/2019(Monday). The written report LIC 624 was received via fax on 08/07/2019. Incident Report stated child was running on the grass when she tripped on her own feet and landed chin first against a bench. LPA toured the facility inside and outside. LPA Powell observed 6 children with 2 teachers outside in the yard. LPA did observed child #1 in the yard full of energy and playful. All children were observed to be cared for and supervised. On the day of the incident there was 1 teacher and 4 children on the playground. Staff #1 stated she observed Child#1 running on grass. Staff#1 immediately helped the child and checked on her chin. Staff #1 also picked child up and placed the child on another bench closer to the first aid kit. Staff#1 cleaned the area that was injured and placed a Band-Aid on child's chin. Staff#1 brought all 4 children into the classroom and called the parent and notified her supervisor of the injury. The child was picked up about 30 minutes. after the initial call to parent. Staff #1 and Staff #3 also called parent to see how the child was doing before leaving for the day. Parent returned call to facility notifying the school that the child was taken to the doctor. The child received 3 stiches under chin. The child was cleared to return to school and no additional treatment was needed. During this inspection, LPA conducted interviews with facility staff. LPA also obtained the copy of the sign in and sign out sheet dated 08/02/2019. Based on the information gathered throughout the course of this investigation, it does not appear this incident was the result of a Title 22 violation.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

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 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: VOALA /HAWTHORNE EARLY HEAD START	FACILITY NUMBER: 197411601
	VISIT DATE: 08/13/2019

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
26
27
28
29
30
31
32

LPA advised the Site Supervisor on how to add email to the Child Care Licensing website at: www.ccld.ca.gov to obtain regulations and quarterly updates. UPDATE: A Child Care Provider's Guide to Safe Sleep poster was provided to the staff during this inspection.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted with Isabel Vitela, Site Supervisor, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

SUPERVISOR'S NAME: Mary Ruiz	TELEPHONE: (424) 301-3061
LICENSING EVALUATOR NAME: Shandra Powell	TELEPHONE: (323) 981-3383
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2019

LIC809 (FAS) - (06/04)

Page: 2 of 2