<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191606358
Report Date: 03/14/2022
Date Signed: 03/14/2022 05:18:48 PM

Document Has Been Signed on 03/14/2022 05:18 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTERFACILITY NUMBER:
191606358
ADMINISTRATOR:KAE CONNORSFACILITY TYPE:
850
ADDRESS:2114 PONTIUS AVENUETELEPHONE:
(310) 445-8993
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY: 90TOTAL ENROLLED CHILDREN: 90CENSUS: 52DATE:
03/14/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:SUMMER SAITO, HEALTH & SAFETY DIRECTORTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/14/2022, Licensing Program Analyst (LPA) Lisa Clayton conducted an unannounced Case Management – COVID-19 inspection at the Samuel Goldwyn Foundation Children’s Center to follow up on reported positive cases of COVID-19. Upon arrival, LPA met with Health and Safety Director Summer Saito. LPA toured the inside and outside of the facility. LPA observed 52 children and 9 staff.
According to the Unusual Incident Reports (LIC 624) 5 children and 1 staff tested positive for COVID-19 within a 2-day period. The students mentioned in the report had been out since 01/07/2022 due to class closure and were expected to return to school on 01/18/2022, but tested positive before the scheduled return date. The staff member had tested negative on 01/02/2022 and returned to the center on 01/03/2022. Later that evening (on 01/03/2022) she wasn’t feeling well and by the next morning she didn’t feel any better and decided to get tested on 01/06/2022 and the result came back positive.

The Health and Safety Director stated that all children and the staff member who tested positive for COVID-19 isolated per LADPH guidelines and were cleared to return to the facility on various days after presenting negative tests.



During the visit, LPA observed COVID-19 related signs/posters throughout the facility. The classrooms are equipped with face masks, wipes, hand sanitizer, and gloves. Children and staff were observed wearing mask indoors and outdoors, LPA emailed PIN 22-10-CCP with Summer and advised that while the mask mandate ended 3/12/2022, the department strongly recommends children and staff continue to wear mask while in areas of close proximity to others.
SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER
FACILITY NUMBER: 191606358
VISIT DATE: 03/14/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During the visit LPA and acting Director discussed the following best practices:

Arrival Procedures – Parents and Staff will do well-ness checks before arrival on the approved school online service. The school will be alerted of any issues and/or if the parent or staff member neglects to complete the questionnaire before arrival.

Isolation area - Isolation area is located in the directors office. A designated staff will stay with the child until the parent arrives. The facility has an isolation restroom for children with symptoms.

Cleaning and Disinfecting - LPA discussed the importance of continuing best practices in an effort to mitigate further spread of Covid-19. Classrooms are sanitized in the morning and evening and throughout the day.

PPE - The facility receives PPE and cleaning supplies through donations and from Bright Horizons. LPA informed the director that these items can also be obtain through the local Resource and Referral agencies.

Reporting Requirements – LPA explained and reminded Licensee to report all outbreaks of COVID-19 positives cases to Department of Public Health. In addition, report all positives cases and closure of facility or classrooms to Community Care Licensing. When reporting Unusual Incidents, reports can be faxed, called in or submitted to the ESROSupportstaff@dss.ca.gov email box within 24 hours and submit Unusual Incident Report within 7 days.

No deficiencies are cited, per Title 22, Division 12, Chapter 3, of the California Code of Regulations.

An exit interview was conducted with Summer Saito and a copy of this report and Notice of Site Visit were provided.

SUPERVISORS NAME: Mary Ruiz
LICENSING EVALUATOR NAME: Lisa Clayton
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2