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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197413515
Report Date: 01/16/2020
Date Signed: 01/16/2020 02:13:50 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:GARDENA EARLY EDUCATION CENTERFACILITY NUMBER:
197413515
ADMINISTRATOR:CHILDRESS, CANDIEFACILITY TYPE:
850
ADDRESS:1350 WEST 177TH STREETTELEPHONE:
(310) 354-5091
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY:168CENSUS: DATE:
01/16/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:PrincipalTIME COMPLETED:
01:52 PM
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On 1/16/2020 Licensing Program Analyst (LPA) Chandler met with Principal Mitchell to follow up on an unusual incident that was received in the El Segundo Regional office on 1/2/2020 regarding a child that appeared to be having an allergic reaction. On 12/20/2019 staff observed swelling in the lips of the child.

During todays visit the child's file was reviewed it was disclosed that the child does have allergies to peanuts. LPA observed recorded documentation regarding the child's allergies i.e.: physician's report, health history,request for special meals and a completed service plan.

Medication was readily available for the child, but staff was instructed not to administer the Epi pen by the 911 dispatcher as the child's current status at the time did not warrant a dosage from the Epi pen.

The child has since returned to school with no further occurrences.

LPA did not observe a physicians note allowing the child to return to class or any instructions following the incident.

LPA requested that the parent submit a doctors note clearing the child to return to school without restrictions.

No further action is warranted.

A copy of this report was signed by the sites designee Ms. Dubon and a copy was provided
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Jillinda ChandlerTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2020
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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