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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419115
Report Date: 05/29/2019
Date Signed: 05/29/2019 10:22:55 AM

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:MALIBU UNDER THE OAKS PRESCHOOLFACILITY NUMBER:
197419115
ADMINISTRATOR:ARMSTRONG, SUNSHINEFACILITY TYPE:
850
ADDRESS:3480 LAS FLORES CANYONTELEPHONE:
(310) 456-7111
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY:45CENSUS: 27DATE:
05/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sunshine Armstrong, LicenseeTIME COMPLETED:
11:00 AM
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On 05/29/2019 at 08:30 am, Licensing Program Analyst (LPA) Sabrina Martinez conducted an inspection at the facility for the purpose of following up on the unusual incident that occurred at the facility on 05/10/2019.

According to the report, on 05/10/2019 at 11:20 am, staff # 1 was pushing child#1 on the swing. Child #1 fell from the swing hitting her head on a rock causing a cut on her head. The child's parents were notified via phone call and immediately arrived to pick up the child. The child was taken to the urgent care and received three stitches in the back of her head. The child came back to school on Monday, 05/13/2019.

During this inspection, LPA conducted interviews with facility staff and the child involved. LPA toured the facility yard and observed it to be free of holes, broken glass and other debris that could pose a hazard. The
playground equipment is securely anchored to the ground and is maintained in a safe condition, free of sharp, loose or pointed parts.LPA also obtained a copy of the sign in and sign out sheet dated 05/10/2019.

Based on the information obtained, it does not appear that this incident was the result of a Title 22 violation for lack of care and supervision.Although the child sustained an injury, staff #1 visually observed the incident and immediately applied ice on the child's head. Parents were also notified immediately.

An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Sunshine Armstrong, licensee.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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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