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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493687
Report Date: 08/05/2021
Date Signed: 08/05/2021 03:35:51 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:CHALK OF WESTWOODFACILITY NUMBER:
197493687
ADMINISTRATOR:NICOLE BROZKAFACILITY TYPE:
850
ADDRESS:2028 WESTWOOD BOULEVARDTELEPHONE:
3104465400
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY:71CENSUS: 33DATE:
08/05/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Nicole Brozka, Director TIME COMPLETED:
03:40 PM
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On 08/05/2021 at 1:10PM Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced a case management - incident inspection at the Chalk of Westwood Preschool for the purpose of following up on the unusual incident that occurred at the facility on 5/26/2021. LPA conducted an initial visit on 6/17/2021. LPA met with Director Nicole Brozka. There are 33 children present with 9 teacher and Director.
According to the report, 5/26/2021, child#1 was playing on the play yard and was coming down the cube climber and fall landing on her right arm.
After the incident, facility applied ice and put on a splint on child’s right arm. Child’s father took child#1 to the urgent care, and a hard cast was placed on child'#1 arm.
Based on information obtained throughout the course of the investigation, it does not appear that the incident was a result of a Title 22 violation. At the time of the incident, there were one adult supervising 3 children at the playground area. Facility staff observed the incident and provided proper care and supervision during the time of the incident. Facility followed Title 22 Regulations in reporting the incident to the Community Care Licensing Division. Facility provided training with all staff regarding outdoor space. LPA obtained a declaration from Director, informing how facility will prevent this type of incident. LPA provided consultation and discussed preventative measures for behavior such as redirection, shadowing, and assessment of placement of materials to ensure the health and safety of children in care and advisory notes was provide.

An exit interview was conducted, a copy of this report and Notice of Site Visit were provided to the director.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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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