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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011557
Report Date: 06/05/2019
Date Signed: 06/05/2019 03:27:48 PM

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:KIRKWOOD CHRISTIAN SCHOOLSFACILITY NUMBER:
198011557
ADMINISTRATOR:ROSA SERRANOFACILITY TYPE:
850
ADDRESS:10822 BROOKSHIRE AVENUETELEPHONE:
(562) 862-4251
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:100CENSUS: DATE:
06/05/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Center DirectorTIME COMPLETED:
03:45 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
Licensing Program Analyst (LPA) Tiffanie Tran arrived at the above facility to conduct a Case Management Incident inspection on a self-reported incident that occurred at Kirkwood Christian Schools on 04/17/19. The facility made the 24 hours self-report on 04/18/19. The Monterey Park South West Office received the writing report on 04/22/19. During the inspection, LPA observed proper care and supervision.

LPA completed child and staffs files review. LPA obtained child's document, children's roster, and personnel report.
LPA conducted interviews and it revealed that during transition time from PM snack to music time S1 observed C1 slipped on a stuffed animal bear sitting between the dramatic area and large group area then hit his forehead on the edge of the fireplace located at the large group area. S1 immediately provided care for C1 and parent was contacted. Child sustained a small open cut on the forehead required glue for the wound area. On the day of the incident, there were five teachers with 33 children. To prevent future accidents, facility staff had covered a foam barrier around the edges of the fireplace. At this time based on the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. No deficiency was found during today's inspection.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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 1