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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198020053
Report Date: 07/12/2021
Date Signed: 07/12/2021 09:58:09 AM

Document Has Been Signed on 07/12/2021 09:58 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
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME:LITTLE ANGELS PRESCHOOL & KINDERGARTENFACILITY NUMBER:
198020053
ADMINISTRATOR:SAVITRI YASODA ABEYAWARDENFACILITY TYPE:
850
ADDRESS:18419 S. AVALON BLVDTELEPHONE:
(310) 819-8629
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY: 48TOTAL ENROLLED CHILDREN: 0CENSUS: 20DATE:
07/12/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Manisha Peiris, DirectorTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Susann Sanchez conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 06/24//2021. Upon arrival, LPA met with Director, Manisha Peiris, who provided LPA a tour of the facility inside and outside. Census was taken at 8:42am.

The incident that occurred on Wednesday 06/23/21, and was reported to the Department on 06/24/21 via email. The facility reported the incident within the required 24 hours.

Based on the information provided during this visit, it was found that child #1 was injured and required medical attention. The child accidentally tripped over ball, when trying to kick it. The child fell and hurt their wrist area resulting in a dislocation. LPA observed the area to be safe. Pictures were taken of the area. A staff did observe the incident when it occurred.

Based on all information obtained on this date, and interviews conducted with staff, ouch reports, there is no follow-up is necessary regarding the incident. The incident appears to be an unusual accident. It appears to be nothing the facility staff could have done to prevent the incident from occurring.

Based on the information obtained and LPA observation of the play area, LPA determined there was adequate supervision provided the day of the incident.

Per California Code of Regulations Title 22, Division 12, no deficiency cited during today's visit. Exit interview conducted with the Director Manisha Peiris.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Appeal Rights were given and explained.
SUPERVISORS NAME: Valarie Cook
LICENSING EVALUATOR NAME: Susann Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2021
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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