197493386-6-2-2020-30-CC-MCON-BQ83DV-20200602181011

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197493386
Report Date: 05/23/2020
Date Signed: 06/02/2020 06:10:20 PM

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:	HAPPY TOTS MONTESSORI SCHOOL		FACILITY NUMBER:	197493386
ADMINISTRATOR:	KHAN, FARHEEN		FACILITY TYPE:	850
ADDRESS:	25405 NORMANDIE AVENUE		TELEPHONE:	(310) 818-9937
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	38	CENSUS: 7	DATE:	05/23/2020
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Farheen Khan, Director		TIME COMPLETED:	03:00 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	Tele-inspection via FaceTime due to the COVID-19 pandemic shelter-in-place orders in the state of California On May 23, 2020 at approximately 1:00 PM, Licensing Program Analyst (LPA) Miriam Cohen conducted an unannounced tele-inspection for the purpose of following up on an Unusual Incident Report received in El Segundo Regional Office on 05/13/2020. The incident occurred on 05/12/2020 at 4:05 PM at Happy Tots Montessori Preschool, 197493386 located at 25405 Normandie Avenue, Harbor City, CA 90710. The incident involved a child who sustained a fracture on her left forearm as diagnosed by the medical doctor. During tele-visit, LPA met with Farheen Khan, preschool director, and announced the purpose for the visit. LPA Cohen interviewed the following individuals: injured child, mother of injured child, primary teacher who supervised the playground during the incident, assistant director, and preschool director/owner. Based on the information obtained during the interviews, there was one teacher supervising six children at the time of the incident; ratios were within compliance. LPA inspected the play structure and observed that the equipment is age appropriate and in good repair. According to the teacher supervising the playground, the child who was injured (C1) was attempting to get in through one of the holes in the play structure when another child (C2) pushed her. Thus, C1 fell and hurt her left forearm. Statement on the Ouch Report disclosed that the primary teacher and assistant director comforted the child, performed assessment, and iced the affected area. The mother of C1 was immediately notified and sought medical assistance on the day of the incident. The child (C1) sustained a fracture in the left forearm and will not be returning to school for at least six weeks per medical provider.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: HAPPY TOTS MONTESSORI SCHOOL	FACILITY NUMBER: 197493386
	VISIT DATE: 05/23/2020

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
26
27
28
29
30
31
32

Narratives from injured child, child’s parent, teacher, assistant director, and director are consistent. LPA concluded that that at the time of the incident there was adequate supervision and no hazards were found in the playground that may have contributed to the child’s fall. The facility followed proper emergency protocol. No deficiency shall be cited.

LPA Cohen suggested for the director to review playground safety procedures with all staff members and to ensure that children are using the playground equipment appropriately. The director was encouraged to continue to report incidents that occur in the facility.

An exit interview was conducted with assistant director and preschool director.

A copy of this report was emailed to preschool director with instruction to reply to the email, which will serve as a signature.

SUPERVISOR'S NAME: Sharalyn Jenkins-Sweeten	TELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Miriam Cohen	TELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2