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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191200549
Report Date: 11/01/2024
Date Signed: 11/01/2024 04:06:15 PM

Document Has Been Signed on 11/01/2024 04:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:VALLEY SCHOOL OF INDIVIDUAL TRAININGFACILITY NUMBER:
191200549
ADMINISTRATOR/
DIRECTOR:		MENESES, HEIDYFACILITY TYPE:
850
ADDRESS:15700 SHERMAN WAYTELEPHONE:
(818) 786-4720
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 101TOTAL ENROLLED CHILDREN: 59CENSUS: 37DATE:
11/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:07 PM
MET WITH:Co Director Porsha RuckerTIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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On 11/1/24 at 2:07PM, Licensing Program Analyst (LPA) Jeanine Lipsey conducted an unannounced, in-person Case management incident inspection. The incident was reported to Community Care Licensing on 10/29/24 via phone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence. The incident occurred on 10/28/24.

Incident: A child fell off a chair and fracture their wrist.

Upon arrival, LPA was guided on a tour of the facility by Porscha Rucker to whom the purpose of the inspection was announced.

Census: There were thirty-seven children being supervised by nine staff.

During the inspection, LPA obtained a copy of the facility roster, Employee roster, and conducted interviews with 3 staff, took photos and made observations of the chair and the area where the incident occurred.



This incident needs further information.

Exit interview conducted and report was reviewed with Co Director Porscha Rucker. A Notice of Site Visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Jeanine Lipsey
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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