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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191606360
Report Date: 10/15/2024
Date Signed: 10/15/2024 01:10:40 PM

Document Has Been Signed on 10/15/2024 01:10 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:
191606360
ADMINISTRATOR/
DIRECTOR:		KAE CONNORSFACILITY TYPE:
830
ADDRESS:2114 PONTIUS AVENUETELEPHONE:
(310) 445-8993
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 17DATE:
10/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Christine Astoque, Facility DirectorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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On 10/15/2024, Licensing Program Analysts (LPA) Judy Laureano and Brittany Lovest conducted a case management inspection to follow up on an Unusual Incident reported to the department on 10/14/2024. LPAs Laureano and Lovest were greeted by Summer Sato Assistant Director and Christine Astoque, Director who guided LPAs on facility tour.

Program operates a School Age License 197414108 and Preschool License 191606358 on same location. LPAs only observed the infant program.

LPAs toured the facility indoor and outdoors and observed the following:

Infant Room- 3 children napping with one staff and 2 children in care with 2 staff in the classroom
Green Room- 6 children and 2 staff members playing outside.
Red Room- 6 children and 2 staff members

The El Segundo Child Care Regional Office (ESRO) received information from director via telephone regarding a self-reporting incident that occurred at the infant program on 10/11/2024 at approximately 10:30. The ESRO office has not received the Unusual Incident Report and director confirmed facility will be submitting shortly.

Based on information, director stated that around 10:30 a.m. the Green classroom was outside in the yard playing. Three staff members (Staff 1, Staff 2 and Staff 3)
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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: 191606360
VISIT DATE: 10/15/2024
NARRATIVE
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and 6 children were in the yard. Staff 1 was in front of the red classroom door near the sand area. Staff 1 reported that Staff 1 propped the door open to speak with Red classroom teachers. Staff 1 walked away, allowing the door to close. Staff 1 then heard a child crying. Staff 2 observed that Child 1 pinched his finger in the door jamb. Child was rendered first aid and parents were notified. Child received medical care and has returned to the child care center.

Based on the information gathered through today’s interviews with staff and director, it was revealed that, on the day of the incident, staff did not have visual supervision of when child 1 inserted his finger in the red classroom door jamb causing child’s finger to be pinched by the door.

Based on the available information: interviews with Site Director, staff and physical observation of the site where the incident occurred, it appears that the incident was the result of a Title 22 violation for lack of supervision. One deficiency was cited during today’s visit in accordance to the California Code of Regulations Title 22, Division 12, Chapter 1.

Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a Type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgment of Receipt (LIC9224) form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit.

An exit interview was conducted, and report was reviewed with Director -Christine Astoque. A copy of this report and appeal rights were discussed and left with the Director, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Judy Laureano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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Document Has Been Signed on 10/15/2024 01:10 PM - It Cannot Be Edited


Created By: Judy Laureano On 10/15/2024 at 12:17 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: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER
FACILITY NUMBER: 191606360

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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Director agrees to view and discussed the video: Supervising Children in Child Care Centers
and submit a list of staff that received training.
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This requirement is not met as evidenced by: Based on the information gathered through today’s interviews with staff and director, it was revealed that, on the day of the incident, staff did not have visual supervision of when child 1 inserted his finger in the red classroom door jamb causing child’s finger to be pinched by the door.
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https://ccld.childcarevideos.org/child-care-center-operators/supervising-children-in-child-care-centers/
Director will also research the possibility of usuing door jamb cover and will notify LPA via email.

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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:Claudia Escobedo
LICENSING EVALUATOR NAME:Judy Laureano
LICENSING EVALUATOR SIGNATURE:
DATE: 10/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/15/2024


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