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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021224
Report Date: 11/19/2024
Date Signed: 11/19/2024 10:53:58 AM

Document Has Been Signed on 11/19/2024 10:53 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:PATHWAYS LAFACILITY NUMBER:
198021224
ADMINISTRATOR/
DIRECTOR:
LAKENDRA WILLIAMSFACILITY TYPE:
850
ADDRESS:1 GATEWAY PLAZATELEPHONE:
(213) 427-2700
CITY:LOS ANGELESSTATE: CAZIP CODE:
90012
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 16DATE:
11/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Shannon Huston, Interm DirectorTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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On November 19, 2024, Licensing Program Analyst (LPA) Monique Ayala conducted an unannounced case management inspection for the above facility. A COVID-19 risk assessment was conducted prior to entering the facility. LPA met with Interm Director, Shannon Huston who guided LPA on a tour of the facility. LPA observed 16 children in care.

The purpose of the inspection is to follow up on an incident report that was reported to the department on 11/05/2024, and the incident occurred on 11/05/2024. The incident report was reported timely.

During the inspection, LPA interviewed Staff #1 (S1) to Staff #2 (S2), obtained a copy of the facility roster, obtained a copy of children sign in sheets for 11/05/2024, staff sign in sheets for 11/05/2024 and internal incident report. LPA observed the play structure to ensure it was age appropriate; play structure displayed a sign indicating it is appropriate for children 2-5 years old. LPA attempted to interview Child #1 (C1), C1 did not want to be interviewed.

During interviews with S1 and S2, S1 observed the incident occur and was approximately 16 feet away. S2 stated she was approximately 3 feet away from C1 and assisted C1 in coming down of the play structure. Per S1 and S2, C1 was running on the play structure and skipped a step leading to the slide when C1 slipped and hit the metal bar on the climbing wall. S1 and S2 stated they applied first aide to C1 when facility director was called for assistance. C1 was picked up from the facility in approximately 5 minutes and was taken to seek medical attention. C1 sustained 3 stitches under his chin.

This was an accident that occurred fast and was unable to be prevented. The facility is not being cited any deficiencies at this time.

An exit interview was conducted and a copy of this report was provided to Interm Director, Shannon Huston along with Appeal Rights. A Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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