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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197493688
Report Date: 03/14/2023
Date Signed: 03/14/2023 03:57:15 PM


Document Has Been Signed on 03/14/2023 03:57 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: 43DATE:
03/14/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Sylvia Ruiz, DirectorTIME COMPLETED:
02:30 PM
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On 03/14/2023 Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced follow-up case management inspection at the above location for the purpose of following up on a self reported unusual incident that was reported on 03/08/2023 by Sylvia Ruiz, Director.. LPA met with Assistant Director Diana Kim. There were 48 napping children with 3 Staff. Green Room 10 Children with Staff #1, Yellow Room with 10 Children with Staff #2, Purple Room with 16 Children with Staff #3.
According to the incident report, on 03/07/2023 child#1 was walking in classroom and child#1 tripped forward and went forehead first into a table, this happened around 10:55am. The table was located in classroom in the front area of the room. Teacher #1 went up to child and held tissue with pressure to a cut next to eye. Teacher #2 called for the Center Director who took child to reception area and wiped the cut off and put a band aid over it. The Assistant Director called and text both parents. The child was picked up around 12:35pm. The child received Glue Stiches from hospital.
During Case Management Inspection LPA conducted interviews with Staff #1 and Assistant Director in classroom. Staff #1 stated children were getting ready for Circle Time and child #1 had just put away something in cubby and was on the way to Circle Time when she tripped and hit the small child table and injured self. LPA toured the classroom area and observed a house like throw rug on the floor which was a tripping hazard to children in care due to rug having tape on bottom of rug to hold onto the floor. LPA observed the rug moving and buckling while walking on top of it. LPA asked staff to remove the rug because it was a tripping hazard to children in care. Staff agreed and the rug was removed during inspection
Based on the information obtained, it does appear that this incident was the result of a Title 22 violation. 101238.3(b) All floors are to be kept clean and safe. An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Sylvia Ruiz, Director.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
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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Document Has Been Signed on 03/14/2023 03:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, THE
FACILITY NUMBER: 197493688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2023
Section Cited

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101238.3 Indoor Activity Space
The floors of all rooms shall have a surface that is safe and clean. Due to LPA observing in the classroom a rug on the floor that was a tripping hazard and unsafe for children in care. This is a potiential health and safety risk to children in care.
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During Inspection the rug was taken up from the classroom floor and a photo of the new child proof rug will be emailed to LPA by POC date if facility plans to replace space with a rug.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) -30-3038
LICENSING EVALUATOR NAME: Shandra PowellTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2023
LIC809 (FAS) - (06/04)
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