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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191608922
Report Date: 08/13/2021
Date Signed: 08/13/2021 09:29:31 PM

Document Has Been Signed on 08/13/2021 09:29 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:NOAH'S ARKFACILITY NUMBER:
191608922
ADMINISTRATOR:JAN LANGFACILITY TYPE:
840
ADDRESS:17661 YUKON AVENUETELEPHONE:
(310) 327-3083
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY: 46TOTAL ENROLLED CHILDREN: 0CENSUS: 13DATE:
08/13/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Director Kathleen ClarkeTIME COMPLETED:
03:30 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 8/13/2021, at approximately 12:45pm, Licensing Program Analyst (LPA), Veronica Wheatley conducted a case management inspection and met with the director Kathleen Clarke. The inspection is regarding an incident that occurred on May 19, 2021 whereby a teacher Staff #1 was found asleep while she was supervising 10 school aged children. Staff #2 went to get a child who was being picked up by a parent/guardian. While going to get a child, Staff #2 observed Staff #1 asleep outside in the outdoor play area in a chair.

A second incident occurred on July 12, 2021 whereby a school aged child #1 was left unsupervised by Staff #3 in the restroom. The teacher Staff #3 was inside of the classroom (gym) when the child was observed by the director and Staff #4. According to Staff #3 statements she heard another child in the classroom (gym) coughing therefore left the child unattended to see about another child.

Based on the investigation and information obtained through interviews, these incidents are being cited for Lack of Supervision. A copy of this report will be provided to all parents that have children enrolled and to new parents enrolling children within the next 12 months.

An exit interview was conducted and a copy of the report was provided to the director.

SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2021
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
Document Has Been Signed on 08/13/2021 09:29 PM - It Cannot Be Edited


Created By: Veronica Wheatley On 08/13/2021 at 02:30 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: 191608922

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/13/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
101229(a)(1)- 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.
1
2
3
4
5
6
7
Staff #1 who was asleep no longer works at the facility effective the day of the incident.Staff #2 who left the child unsupervised will be attending classes regarding supervision and health and safety. LPA is recommending an inservice for all staff regarding Care & Supervision. A copy of the certificates will be submitted to the department immediately after completion. In addition the department videos will be reviewed.
8
9
10
11
12
13
14
Based on interviews which were conducted on May 19, 2021 Staff #1 was observed sleeping while supervising 10 school aged children. On July 12, 2021, Child #1 was observed unsupervised by Staff #3 This poses an immediate health, safety risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 08/13/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/13/2021


LIC809 (FAS) - (06/04)
Page: 2 of 2