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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414037
Report Date: 10/25/2023
Date Signed: 10/25/2023 02:55:45 PM

Document Has Been Signed on 10/25/2023 02:55 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CCRC HEAD START - RESEDAFACILITY NUMBER:
197414037
ADMINISTRATOR:ARACELI GROSSMANFACILITY TYPE:
850
ADDRESS:18120 SATICOY STREETTELEPHONE:
(818) 705-0113
CITY:RESEDASTATE: CAZIP CODE:
91335
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 26DATE:
10/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sy Hearn- Teacher DesigneeTIME COMPLETED:
02:55 PM
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On 10/25/2023 Licensing Program Analyst (LPA) Doris Whitmore conducted an unannounced Case Management- Incident inspection for the purpose of following up on an Unusual Incident Report (UIR). LPA met with Sy Hearn, Teacher Designee. LPA toured the facility inside and outside. LPA observed 26 children in care for the entire school. There were 10 children in care in classroom #1 where incident took place. and 4 staff. According to the UIR, on 10/23/2023 Child#1 ran in the classroom and lost his balance and hit the inside of his lip. Incident happened on 10/20/2023.

During the investigation LPA interviewed Staff #1,& Child #1 & spoke to the Parent of child#1.LPA reviewed the sign in sheet from October 20, 2023, Ouch Report & doctors' note.

Per Title 22, Division 12, Chapter 3, California Code of Regulations, no deficiencies are cited. An exit interview was conducted. A copy of this report (LIC809) and Notice of Site Visit were provided to the Teacher Designee Sy Hearn.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2023
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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