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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014185
Report Date: 01/15/2020
Date Signed: 01/15/2020 11:48:20 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:KID WORKS CHILDREN'S CENTERFACILITY NUMBER:
198014185
ADMINISTRATOR:RANASINGHE, D.FACILITY TYPE:
850
ADDRESS:3621 E. BROADWAYTELEPHONE:
(562) 438-4904
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:50CENSUS: DATE:
01/15/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Dinuka RanasingheTIME COMPLETED:
12:08 PM
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An unannounced Case Management Inspection was conducted on this day by Licensing Program Analyst (LPA) Raul Navarro to address an Unusual Incident Report that was received in the licensing office on 07/12/19. LPA met with Director Dinuka Ranasinghe who guided LPA on a tour of facility of both indoors and outdoors.

On 07/12/19, Child #1 was running up a couple of steps into the sand box. Child tripped on the step and fell on his arm and stomach. Child was sent to the "up front teacher" to assess injury and administer first aid. Child then went inside for rug time. Per staff interviewed, child was not crying but he was also not participating in hand movements to songs. After about 20 minutes teachers noticed Child holding right arm, dad was called and picked up child about 30 minutes after. Child was taken to the see medical attention. Child sustained a broken arm.

LPA interviewed staff present during inspection. Staff stated they observed the incident as it happened. Based on all information obtained on this date, and interviews conducted with teachers, no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring. There were no deficiencies observed in regards to today's visit.
SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 980-4934
LICENSING EVALUATOR NAME: Raul NavarroTELEPHONE: 323-981-3388
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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