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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011557
Report Date: 02/27/2020
Date Signed: 02/27/2020 03:36:23 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:
5628624251
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:100CENSUS: 72DATE:
02/27/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:DirectorTIME COMPLETED:
03:50 PM
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Licensing Program Analysts (LPAs) T. Tran and B. Baluyot while conducting a Case Management inspection at Kirkwood Christian Schools on 02/27/2020, upon touring the facility outdoor play area, LPAs observed an incident involving a child who tripped and hit child's face on play structure ladder. LPA's observed proper care and supervision.

LPAs completed child and staff files review and obtained child's documents. Based on the information that was gathered through interviews and observation, there were two staff members supervising 11 children in the playground area.

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 cited.

The content of this report was read and discussed in detail with the noted 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: 02/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2020
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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