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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493688
Report Date: 12/05/2022
Date Signed: 12/05/2022 03:17:54 PM


Document Has Been Signed on 12/05/2022 03:17 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:ACADEMY AT MANHATTAN BEACH, THEFACILITY NUMBER:
197493688
ADMINISTRATOR:WESSEL, VIDAFACILITY TYPE:
850
ADDRESS:1114 22ND STREETTELEPHONE:
(310) 546-1700
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:125CENSUS: 37DATE:
12/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Sylvia RuizTIME COMPLETED:
03:35 PM
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On 12/5/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on an Unusual Incident reported to the department by telephone on 10/14/2022. LPA was greeted by DIrector, Sylvia Ruiz and toured the facility and took a census of the children. Upon arrival, there were 37 children and 8 staff present today at the facility for the Preschool.

Description of the incident: On 10/13/2022 at approximately 9:15am, C1 was walking into the gym with classmates. C1 began to run towards the front of the line and tripped. C1 hit the corner of the wall and cut his forehead open. Staff applied pressure and parent was called. Parent arrived within 15 minutes. Parents took C1 to urgent care and child received stitches later that evening.

During this inspection, LPA interviewed staff, obtained a copy of the facility roster, inspected the outdoor area where incident happen.

Based on the information provided and interviews conducted the incident will require further investigation.

An exit interview was conducted, a copy of this report and notice of site visit was provided to Director.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
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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