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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416694
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:50:06 PM

Document Has Been Signed on 12/12/2023 04:50 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:WASHINGTON PRIMARY CENTERFACILITY NUMBER:
197416694
ADMINISTRATOR:ALLISON SPEIGHTFACILITY TYPE:
850
ADDRESS:860 W. 112TH STREET RM K1 & K2TELEPHONE:
(323) 779-7550
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 8DATE:
12/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Mary Seay, Principal TIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Lilia Hernandez conducted an unannounced case management inspection due to an incident that occurred on 12/05/2023. LPA arrived at the facility at 1:01PM and met with Mary Seay, Principal, who guided LPA on a tour of the facility. There were 8 children and 2 staff present upon arrival.

The purpose of the visit was to follow-up on an incident that was reported to the department.

LPA Hernandez conducted interviews and obtained documentation during this visit.

The incident that occurred on 12/05/2023, was reported to the Department on 12/05/2023, via telephone. The facility reported the Unusual Incident to the Department within the required 24 hours of occurrence.

Information reported to the Department indicated that Staff #3 may or may not have violated the personal rights of child# 1.

Based upon information received today, further information is needed to determine if the personal rights of child #1 were violated.

There were no deficiencies cited during today’s inspection.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Mary Seay, Principal.
SUPERVISORS NAME: Rita Ramos
LICENSING EVALUATOR NAME: Lilia Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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