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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494267
Report Date: 12/20/2019
Date Signed: 12/20/2019 11:08:45 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:WEBSTER SEASIDE PRESCHOOLFACILITY NUMBER:
197494267
ADMINISTRATOR:DR SUSAN SAMARGE-POWELLFACILITY TYPE:
850
ADDRESS:3602 WINTER CANYONTELEPHONE:
(310) 456-6494
CITY:MALIBUSTATE: CAZIP CODE:
90265
CAPACITY:24CENSUS: 10DATE:
12/20/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Laila Daruti, Principal and Flavia Reed, Lead TeacherTIME COMPLETED:
11:30 AM
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On 12/20/2019 at 09:00 am, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Webster Seaside Preschool located at 3602 Winter Canyon, Malibu, CA 90265 for the purpose of following up on the unusual incident that occurred at the facility on 12/05/2019. The Unusual Incident/Injury Report (UIR) was received by the El Segundo Regional Office on 12/09/2019.

According to the report, on 12/05/2019, during center time, child#1 was playing with play dough. When the teacher got up to help another student, child#1 left the class via bathroom door. The teacher saw that the student had left and went to search for the child. The child had left the bathroom to the adjoining class and left the other class. The coach saw the child and brought the child back to class as the teacher was coming out to get the child.

During this inspection, LPA conducted interviews with facility staff and reviewed the child's records. LPA was unable to interview the child involved in the incident due to the child being picked up early from school.

At this time, further investigation is needed.

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

DATE: 12/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2019
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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