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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197419005
Report Date: 08/01/2023
Date Signed: 08/01/2023 03:50:56 PM

Document Has Been Signed on 08/01/2023 03:50 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CII/SOUTH VERMONT HEAD STARTFACILITY NUMBER:
197419005
ADMINISTRATOR:GEORGETTE BRADLEYFACILITY TYPE:
850
ADDRESS:9022 S. VERMONTTELEPHONE:
(213) 385-5100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: DATE:
08/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Benita ThompsonTIME COMPLETED:
03:50 PM
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On 08/01/2023 at 2:17 p.m.Licensing Program Analyst ( LPA) Doris Whitmore conducted an unannounced Case Management for the purpose of incident Report( UIR) that occurred on 04/27/2023. At the time of the visit there was a total of 9 teachers present and 8 children. LPA met with Benita Thompson and informed the nature of the visit. LPA Whitmore interviewed Staff #1 Staff#2 was absent.LPA Whitmore was unable to interview child#1 during the visit child left for the day at 1:30p.m. LPA Whitmore reviewed child#1 file.
According to the UIR parent of child#1 called to report that child had a crayon stuck in his nose.
Based on the information obtained and interviews conducted at this time further investigation is needed. An exit interview was conducted and a copy of this report along with the Notice of Site Visit was provided to Benita Thompson.
SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Doris Whitmore
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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