<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198004772
Report Date: 04/25/2019
Date Signed: 04/30/2019 08:27:23 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:COUNTY KIDS' PLACEFACILITY NUMBER:
198004772
ADMINISTRATOR:RODRIQUEZ, ELVIAFACILITY TYPE:
850
ADDRESS:2916 HOPE ST.TELEPHONE:
(213) 744-6241
CITY:LOS ANGELESSTATE: CAZIP CODE:
90007
CAPACITY:59CENSUS: 31DATE:
04/25/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:25 PM
MET WITH:Edith M. Lowery Assistant DirectorTIME COMPLETED:
06:25 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 4/30/2019 Licensing Program Analyst (LPA) Denise Miranda conducted an unannounced visit to County Kid’s Place in order to deliver the AMENDED Report for Case Management – incident conducted on 4/25/2019.

On 4/25/2019 at 4:25pm Licensing Program Analyst LPA Miranda arrived at the facility for the purpose of delivering the investigation findings of the unusual incident that occurred at the facility on 4/1/2019.

According to the report that the Department received on 4/2/2019 around 11:30am while child#1 was outside at the playground on the rocking climbing structure, child decided to stand on the peak of the structure. Staff#1 was going tell the child do not stand on the structure, when child#1 lost his balance and his wrist caught his fall. Child#1 was brought to the office, staff placed ice pack and stabilized wrist with a card board and taped for child no to move his wrist.

Based on the information gathered throughout the course of the investigation, it was revealed that on 4/1/2019, staff#1 observed when child#1 was playing on the rocking climbing and observed when child stood on the peak of the structure. Based on the information that LPA obtained from Staff#1, her station at the playground was approximately 29 feet from the rocking climbing structure and staff#2 was approximately 45 feet from the rocking climbing structure. Facility staff failed to provide proper supervision and failed to make sure that child was properly using playground equipment and don't engage in unsafe behavior around it. As a result, child #1 fell off the rocking climbing and sustained a broken arm PPI NATL (left arm). Medical attention was required.


Today a Civil Penalties of $500.00 was issued.
On 04/25/2019, the facility shall be cited a type "A" deficiency per the California Title 22 Regulations. The deficiencies were cited on the Facility Evaluation Report LIC 809-D.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: COUNTY KIDS' PLACE
FACILITY NUMBER: 198004772
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/26/2019
Section Cited
CCR
101229(a)
1
2
3
4
5
6
7
Amended
Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. This requirement is not met as evidence by 4/1/19, facility staffs failed to provide proper supervision and failed to make sure that child was properly use
1
2
3
4
5
6
7
The facility has condcuted a staff meeting on the topics of Playground safety and supervision. LPA obtained a copy of the training agenda as well as staff sign in on 04/12/2019.
Licensee will create and provided a copy of a playground supervision zones for each teacher to ensure every section on the playground is covered by
8
9
10
11
12
13
14
playground equipment and don’t engage in unsafe behavior around it. As result Child#1 fell from rocking climbing apparatus and sustained a broken arm. This is an immediate health and safety risk to the child in care.

8
9
10
11
12
13
14
teacher. Licensee will send by email no later than 4/26/2019.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jennie FerreiraTELEPHONE: (424) 301-3067
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2