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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191225860
Report Date: 09/08/2023
Date Signed: 09/08/2023 11:44:25 AM

Document Has Been Signed on 09/08/2023 11:44 AM - It Cannot Be Edited

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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ST. MARK'S DAY SCHOOLFACILITY NUMBER:
191225860
ADMINISTRATOR:SUSIE FOWLER KENNYFACILITY TYPE:
850
ADDRESS:1020 N. BRAND BLVD.TELEPHONE:
(818) 240-3860
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY: 102TOTAL ENROLLED CHILDREN: 70CENSUS: 52DATE:
09/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Julia Peacock, DirectorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Anomeh Eivazian conducted an unannounced case management- Incident inspection on 09/08/23 at 11:0 AM due to an incident that occurred on Tuesday, April 11, 2023. LPA met with Julia Peacock, Director who guided analyst on a tour of the facility.

Alleged Incident took place on 04/11/23. Incident was reported via email next working day. Original LIC 624 Unusual Incident/Injury Report form was received by the Department within 7 days. The written incident report was received by email on Wednesday, 04/12/23. The facility reported the incident within the required 24 hour time frame.

LPA observed the area where alleged incident took place. Incident occurred on the backyard grass area of Garden playground by the back wall. Per director, Julia Peacock and staff#1 who observed the incident, child#1 ran into the perimeter wall and bumped her chin. Child #1 sustained a cut on chin and received four stiches and a tooth was extracted.

On 09/08/23 at 11:10 AM, LPA Eivazian accessed the area where the incident occurred, the ground was observed to be safe, covered with artificial grass and LPA did not observe any hazards on the back wall. (Pictures were taken).

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today from the areas that were inspected today.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Julia Peacock, director at 12:00 PM.

SUPERVISORS NAME: Christina Gabelman
LICENSING EVALUATOR NAME: Anomeh Eivazian
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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