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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 04/12/2022
Date Signed: 04/12/2022 10:27:01 AM


Document Has Been Signed on 04/12/2022 10:27 AM - It Cannot Be Edited

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:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:GEORGETTE BRADLEYFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:55CENSUS: 9DATE:
04/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Georgette Bradley-Site SupervisorTIME COMPLETED:
10:30 AM
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On 4/12/2022 Licensing Program Analyst (LPA) Judy Laureano conducted a case management visit to follow up on an Unusual Incident Report, received on 3/28/2022. LPA was greeted by director Ms. Georgette Bradley, Site Supervision. LPA observed classroom 1- HS-CDE01 with 9 children and 3 staff member.

LPA toured the classroom and outside playground. LPA observed the children’s apparatus where the incident took place.



On 3/23/2022 at approximately 11:00 am C1 was playing in the slide and slid head first and landed on his arm. Child slid on his stomach, C1 started to cry and S1 attended to him and S2 stepped in to provide assistance and contact parent. Parent was contacted and picked up child. Parent took child to the Dr. Parent contacted S2 and informed her that child has a fracture and will have a cast and need modification. C1 was back in care the next day.

LPA observed that the playground surface is maintained and in safe condition, with sufficient cushioning underneath to absorb a fall. All other playground equipment appears to be safe, in good repair and there are ample age appropriate toys, children’s apparatus age recommendation is from 2 years old to 5 years old.

Based on interviews with parent, staff and LPA’s observations, LPA Laureano finds that there was appropriate supervision, the apparatus was age appropriate and it does not appear that the incident was a result of Title 22 violation.

There are no deficiencies cited during today's inspection. A copy of this report and notice of site visit was provided to Site Director Georgette Bradley,
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Judy LaureanoTELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2022
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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