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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602130
Report Date: 08/12/2021
Date Signed: 08/13/2021 08:46:09 AM

Document Has Been Signed on 08/13/2021 08:46 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:NOAH'S ARKFACILITY NUMBER:
191602130
ADMINISTRATOR:KATHLEEN CLARKFACILITY TYPE:
850
ADDRESS:17661 S. YUKON AVE.TELEPHONE:
(310) 327-3083
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 59TOTAL ENROLLED CHILDREN: 0CENSUS: 23DATE:
08/12/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kathleen ClarkeTIME COMPLETED:
03:00 PM
NARRATIVE
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On 8/12/2021 at approximately 1:30PM Licensing Program Analyst, Veronica Wheatley conducted a case management inspection regarding an incident that occurred June 28, 2021.

According to the director, Child #1 was with her in the school office. The child ran out of the office and down the hallway about to exit the building. The director stated that she chased after the child and was able to to reach the child in which she grabbed the child by the back of his neck to stop the child from exiting the building. Director stated I told him "we do not run at school" and took him by the hand and walked with him back to her office.

LPA interviewed several staff members of which one staff member #1 observed the incident.

Based on the investigation and information obtained through interviews the facility is being cited.

See LIC 9099D.

Exit interview.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2021
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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Document Has Been Signed on 08/13/2021 08:46 AM - It Cannot Be Edited


Created By: Veronica Wheatley On 08/12/2021 at 03:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: NOAH'S ARK
FACILITY NUMBER: 191602130

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights
(a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs....This requirement was not met as evidenced by:
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The director will take a class regarding personal rights and also conduct an all staff meeting with the staff regarding Personal Rights. The director will inform the department of the class and meeting by 8/13/2021. Parents will be provided a copy of the report.
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Based on interviews which were conducted the Director failed to protect Child #1's personal rights. Although the director was trying to protect the child who was running out of the building, the child was grabbed by the neck which poses an immediate health, safety or personal rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Maureen Neal
LICENSING EVALUATOR NAME:Veronica Wheatley
LICENSING EVALUATOR SIGNATURE:
DATE: 08/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2021


LIC809 (FAS) - (06/04)
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