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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494840
Report Date: 02/08/2024
Date Signed: 02/08/2024 02:43:27 PM

Document Has Been Signed on 02/08/2024 02:43 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:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
197494840
ADMINISTRATOR:ERENDIDA ROMEROFACILITY TYPE:
850
ADDRESS:13562-13548 VENTURA BLVDTELEPHONE:
(818) 783-2930
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY: 138TOTAL ENROLLED CHILDREN: 97CENSUS: 64DATE:
02/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:ERENDIDA ROMEROTIME COMPLETED:
02:43 PM
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On 02/08/2024, Licensing Program Analyst (LPA) Suzette Ornelas conducted a case management visit at facility mentioned above for the purpose of investigating the incident that occurred at the facility on 01/23/2024. LPA met with Director, ERENDIDA ROMERO and toured the facility indoor and outdoor.

The Department received the Unusual Incident Report via phone call on 01/24/2024. According to the report, on 01/23/2024, at approximately 11:30 AM, Child 1 (C1) was playing outside during play time, jumped off an apparatus onto the grass area and rolled under the play structure. Teacher 1 (T1) assisted C1 and noticed C1's arm was injured. Director stated that first aid was administered by applying an ice pack and splint and parents were notified. C1 was picked up by their parent and received medical attention. Director stated that C1's parents were contacted to obtain an update and it was confirmed that the C1 sustained a broken forearm.

During this visit, LPA observed 64 children being supervised by 13 staff. LPA made observations, conducted interviews and obtained pictures of the area where the incident occurred.

An exit interview was conducted and a copy of this report and Notice of Site Visit were provided to Director, ERENDIDA ROMERO.
SUPERVISORS NAME: Betty Bell
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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