198020337-3-24-2023-33-CC-VMGA-CQ8RUJ-20230324131958

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198020337
Report Date: 03/24/2023
Date Signed: 03/24/2023 01:20:05 PM

Document Has Been Signed on 03/24/2023 01:20 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
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	SEGRAY EAGLE ROCK		FACILITY NUMBER:	198020337
ADMINISTRATOR:	JENNIFER LEMAY LANDA		FACILITY TYPE:	850
ADDRESS:	4475 EAGLE ROCK BLVD.		TELEPHONE:	(323) 507-2640
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90041
CAPACITY: 155	TOTAL ENROLLED CHILDREN: 155	CENSUS: 69	DATE:	03/24/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Director Jennifer LeMay Landa		TIME COMPLETED:	01:25 PM

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Licensing Program Analyst (LPA) Veronica Martinez Garza conducted an unannounced Case Management incident inspection at the above facility on 03/24/23 at 09:03AM. A COVID-19 risk assessment was conducted prior to entering the facility. LPA wore appropriate personal protective equipment. LPA met with Director, Jennifer LeMay Landa who guided LPA on a tour of the facility. Census was taken.

On 02/28/23 at approximately 09:30AM Child 1 (C1) and Child 2 (C2) were playing at the Mulberry Tree C2 pushed C1 off causing C1 to fall. C1 fell hitting his head sustaining a 1.5 inch cut on the right side of his upper forehead. The facility provided first aid and called parents of C1. Parent 2 (P2) picked up C1 and took C1 to Urgent Care. C1 received 2 staples. C1 returned to the facility on 03/01/23.

During this investigation, LPA interviewed: staff, child #1 (C1), child #2 (C2), parent 1 (P1), parent 2 (2), obtained a copy of facility roster, obtained a copy of BrightWheel parent messages of C2, email documentation with the development specialist, modification of class schedule, and reviewed file of C2.

Based on the interviews with Staff 1-7, staff 4 observed C1 and C2 running but did not observe C2 push C1. Staff 2,3 and 5 immediately assisted C1 when he was heard crying. S2 comforted C1 and took him to the office to provide first aid. Per staff 2-7, they have observed C2 to be aggressive towards other children in care and have discussed these observations with the director. Director contacted development specialist for assistance regarding C2 aggressive behavior. Per director, development specialist made observations on the following dates: 01/17, 01/24, 01/31 and recommended for facility to continue doing focus activities and small group activities to facilitate his social skills and impulse control with C2. Per director, facility staff began shadowing C2 and due to C2 behavior improvements, the facility has decided not to shadow C2 but are 100% supervising. LPA observed and took pictures of the playground where the incident occurred and did not observe any hazardous materials.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: SEGRAY EAGLE ROCK	FACILITY NUMBER: 198020337
	VISIT DATE: 03/24/2023

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LPA reviewed file of C2 but there were no other incidents documented. LPA asked director if there was any documentation regarding C2 aggressive behavior; director provided LPA with a copy of the incidents entered on the BrightWheel application, emails with the development specialist, and parent messages on the BrightWheel application. LPA reviewed all incidents documented on the BrightWheel application dating back to 11/09/22. There are a total of 6 documented entries of C2 aggressive behavior towards other children in care. Incident 02/28/23 would be the 7th incident but was not documented on the BrightWheel application. LPA observed that the facility has been aware of C2 aggressive behavior towards other children in care and has been working with C2 parents, development specialist, therapist and staff to provide the services necessary to meet the needs of C2. Director contacted the development specialist in December 2022 to assist and continues to work with the facility. C2 parents contacted a therapist who came to the facility on 03/22 to observe C2 interactions and behaviors. Facility is waiting for C2 parents to communicate the therapist findings. Though this was an accident, staff did not observe this incident. Facility has been working with C2 parents and have been using all available resources to meet the needs of C2.

Based on interviews and documents received, there are no deficiencies being cited. The facility followed all proper procedures; Staff administered first aid, child’s parent were notified, and incident report was sent in a timely manner.

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, a civil penalty of $100 can be assessed.

Exit Interview was conducted, and appeal rights were given, along with a copy of this report was provided to the director, Jennifer LeMay Landa.

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SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Veronica Martinez-Garza
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC809 (FAS) - (06/04)

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