192006309-8-22-2023-33-CC-MJAA-CUXVE7-20230822162153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 192006309
Report Date: 08/22/2023
Date Signed: 08/22/2023 04:22:01 PM

Document Has Been Signed on 08/22/2023 04:22 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	ALEGRIA AFTER SCHOOL PROGRAM		FACILITY NUMBER:	192006309
ADMINISTRATOR:	VICTORIA REED		FACILITY TYPE:	840
ADDRESS:	2737 SUNSET BOULEVARD		TELEPHONE:	(323) 454-4200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90026
CAPACITY: 21	TOTAL ENROLLED CHILDREN: 21	CENSUS: 5	DATE:	08/22/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	02:08 PM
MET WITH:	Victoria Reed, Child and Family Education Coordinator		TIME COMPLETED:	04:30 PM

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On August 22, 2023, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the above facility. The purpose of the inspection is to follow up on an incident that occurred on 08/10/2023; the incident was reported timely to the department. LPA met with Victoria Reed, who guided LPA on a tour of the facility. LPA observed 5 children in care with 2 staff.

Brief Summary: While playing kick ball with his peers Child #1 (C1) was running, tripped over his feet and hit his face on a bench. Upper eye area began bleeding profusely. C1 was taken via ambulance to hospital where he received 7 stiches.

During the inspection LPA obtained a copy of sign in sheets for the day of the incident, a copy of the incident report, a copy of the facility roster, a copy of the doctor clearance note, LPA interviewed C1-C3, Staff #1 (S1)-S2 and Parent #1 (P1). S1-S2. LPA reviewed staff files.

Based on interviews conducted with C1-C3 it was stated that, C1 was playing kick ball with C2 and C3 in the outside play yard. Per C1-C3, C1 was at third base and was running to home (lunch table). Per C1-C3, C1 tripped and hit his left upper eyebrow on the bench and landed on the cement floor. Per C1, he got up and noticed he was bleeding. Per C1-C3 and S1-S2, S1 assisted C1 in getting up and applying pressure to C1 injury. S1 and S2 stated that S1 brought C1 into the classroom and applied a gauze while continuing to add pressure. S2 stated that C2 called P1 notifying her of the incident that occurred with her sibling (C1). S2 stated there is a language barrier and S1 was assisting with C1. Per C1-C3 teachers were present during the time of the incident and observed the incident occur.

There are no deficiencies being given at this time as this incident was an accident that occurred fast and was unable to be prevented.

An exit interview was conducted and a copy of this report was provided to Victoria Reed, Child and Family Education Coordinator along with Notice of Site Visit and Appeal Rights.

SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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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