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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494840
Report Date: 05/22/2024
Date Signed: 06/18/2024 10:54:05 AM

Document Has Been Signed on 06/18/2024 10:54 AM - 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/
DIRECTOR:		ERENDIDA ROMEROFACILITY TYPE:
850
ADDRESS:13562-13548 VENTURA BLVDTELEPHONE:
(818) 783-2930
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY: 138TOTAL ENROLLED CHILDREN: 102CENSUS: 67DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:08 PM
MET WITH:Vino Veerasingam and ERENDIDA ROMEROTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 5/22/2024, 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 5/16/2024. LPA met with Assistant Director, Vino Veerasingam and toured the facility indoor and outdoor.

During this visit, LPA observed 67 children being supervised by 12 staff.
LPA made observations, conducted interviews and obtained pictures of the area where the incident occurred.

The Department received the Unusual Incident Report via phone call on 5/17/2024. According to the report, on 5/16/24, at approximately 3:20PM, Child 1 (C1) fell off playground structure, C1 was standing on play structure, somehow slipped landing in a position that caused her to hurt their left shin/leg. Parent (P) was called. Child was taken to urgent care diagnosed with a broken leg. C1 has yet to return to school.

An exit interview was conducted and a copy of this report and Notice of Site Visit were provided to Assistant Director, Vino Veerasingam and Director, ERENDIDA ROMERO
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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