197493116-3-19-2025-30-CC-JLIY-DEWQTT-20250319122738

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493116
Report Date: 03/19/2025
Date Signed: 03/19/2025 12:27:55 PM

Document Has Been Signed on 03/19/2025 12:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	CCRC HEAD START - MELVIN		FACILITY NUMBER:	197493116
ADMINISTRATOR/ DIRECTOR:	NEREYDA LEVINGS		FACILITY TYPE:	850
ADDRESS:	7700 MELVIN AVENUE		TELEPHONE:	(818) 700-4406
CITY:	RESEDA	STATE: CA	ZIP CODE:	91335
CAPACITY: 40	TOTAL ENROLLED CHILDREN: 32	CENSUS: 29	DATE:	03/19/2025
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:50 AM
MET WITH:	Claudia Lopez Family Advocate		TIME VISIT/ INSPECTION COMPLETED:	12:40 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	On 3/19/25 at 8:50AM, Licensing Program Analyst (LPA) Jeanine Lipsey conducted, a Case management incident inspection. The incident was reported to Community Care Licensing on 3/10/25 via phone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. The incident which occurred on 3/10/25 was that the child #1 (C1) fell off the monkey bars and injured their left arm. Upon arrival, LPA was guided on a tour of the facility by Claudia Lopez Family Advocate , to whom the purpose of the inspection was announced. Census: There were twenty nine children being supervised by seven staff. On todays visit, LPA interviewed 3 staff, 1 parent, took photos of the play structure and measured the monkey bars distance from where the child fell to the ground, obtained a copy of the facility roster, ouch report, Medical Referral, and the doctors note stating the restrictions. Director Pamela Youngblood arrived at 9:52am. The incident occurred at about 9:20am, during morning playtime which is 8:45am to 9:30am. Staff #1 (S1) was standing near the play structure and noticed C1 try to reach the first pole on the monkey bar but missed and fell on their arm. C1 cried and complained their arm was hurting. S1 stated they dived to catch C1 but could not and fell on their knee. S1 stated they immediately picked up C1, carried them to the bench, applied an ice pack from the emergency kit then took C1 to the classroom where Parent (P1) was called. P1 stated they were called at 9:38am to pick up C1 who was crying. P1 stated they made it to ER by 10:10am. P1 stated they were told that C1 fell from the monkey bars and complained their arm was hurting. Per P1, C1 broke elbow had surgery to insert three pins. C1 has returned to class on 3/17/25 with a cast on the left elbow and per P1, C1 is back to normal except for the cast. The doctor gave restrictions of no sand, no water, no rough play and no climbing.

Betty Bell	TELEPHONE: (424) 301-3063
Jeanine Lipsey	TELEPHONE: (424) 301-3077
	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CCRC HEAD START - MELVIN	FACILITY NUMBER: 197493116
	VISIT DATE: 03/19/2025

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Per all staff interviewed this is the first injury of a child on the monkey bars. Staff also stated with doctors restrictions they have put in place that a teacher stays close to C1 to make sure children are not playing roughly near them, and a teacher stays in the class with C1 while the children play outside. If child wants to go outside, Staff will sit with child at a table to supervise.

LPA arrived during morning playtime and observed C1 in the classroom with a teacher coloring while the other children played outside. LPA observed the monkey bars, the cushion underneath and took measurements from the bar to ground where C1 fell was The length was 60 inches. Per Director, the play structure was installed before the center was here and per the sticker attached, it is safe for children ages 2 to 5 years.

Per Director the play yard is shared with the transitional kindergarten and kindergarten they use it at different times. Per Director they have a waiver to use the play yard.

In order to prevent this incident from reoccurring, Per Director staff will continue to supervise children at play, station themselves near the play structure and prevent the children from climbing the monkey bars. Staff will talk to the children before play time and tell them not climb the monkey bars. The department finds there was not a deficiency in compliance.

Exit interview conducted and report was reviewed with Director Pamela Youngblood. A Notice of Site Visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Betty Bell	TELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Jeanine Lipsey	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC809 (FAS) - (06/04)

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