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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197417030
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:13:41 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:FRIENDSHIP ACADEMY-LOMITAFACILITY NUMBER:
197417030
ADMINISTRATOR:ALMA SALINASFACILITY TYPE:
850
ADDRESS:2155 W. 240TH STREETTELEPHONE:
(310) 707-1422
CITY:LOMITASTATE: CAZIP CODE:
90717
CAPACITY:49CENSUS: 25DATE:
08/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Alma Salinas, DirectorTIME COMPLETED:
01:30 PM
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On 08/17/2021 @ 10:00 AM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Incident inspection to follow up on the self reported incident that occurred on 06/15/2021 at Friendship Academy – Lomita, CA 197417030 located at 2155 West 240th Street, Lomita, CA 90717. The El Segundo Regional Office received the incident report on 06/14/2021. Upon arrival, LPA observed proper care and supervision. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.

Based on the information that were gathered through interview, observation, and record reviews, it revealed that, on the day of the incident, there were two adults supervising 11 children. Per interview, S1 documented that during work time, C1 and C2 were observed playing with the wooden blocks in the designated area. During play, S1 observed C2 reached for the magnetic tiles and hit C1 on the left side of the head near the eyebrow. S1 informed S2 about the incident. S1 took tissues and provided first aid on C1. Parent was notified at 10:17 AM and C1 was picked up by parent @ 10:30 AM. C1 was taken to the hospital for medical attention. On 06/15/2021, preschool director followed up on the wellness of C1 and was informed by parent that C1 received medical treatment and would be kept home on 6/15/2021. As part of action taken, director removed wooden blocks out of the classroom and replaced them with soft blocks. Teachers will work on re-introducing wooden block materials back into the classroom accordingly. Teachers will provide activities that demonstrate conflict resolution and developing social skills such as sharing with others.

At this time based on the available information, it does not appear 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 with the noted contact person. An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
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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