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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602265
Report Date: 02/28/2022
Date Signed: 02/28/2022 12:05:06 PM


Document Has Been Signed on 02/28/2022 12:05 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SOUTHWOOD PRE-SCHOOLFACILITY NUMBER:
191602265
ADMINISTRATOR:COATES, GLADYSFACILITY TYPE:
850
ADDRESS:22422 PALOS VERDES BLVDTELEPHONE:
(310) 540-9084
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:156CENSUS: 124DATE:
02/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Gladys Coates, Preschool DirectorTIME COMPLETED:
12:20 PM
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n 02/28/2022 at 10:30 AM, Licensing Program Analyst (LPA) Miriam Cohen made an unannounced visit and met with Gladys Coates, Preschool Director, for the purpose of investigating regarding the Unusual Incident/Injury Report (UIR) that took place on 01/28/2022 at Southwood Preschool 1971602265 located at 22422 Palos Verdes Blvd., Torrance, CA 90505. The UIR was reported on 01/28/2022 to El Segundo Child Care Regional Office. Upon arrival, LPA observed 17 staff members providing care and supervision to 124 children. All center staff that was present during today’s inspection had fingerprint clearance and associated to the designated license number.
During today’s inspection, Gladys Coates and LPA Cohen toured the playground where the incident occurred.
LPA obtained copies of the following: Ouch Report, Physician’s Report with diagnosis and notice for child to return to school, and Emergency ID for the child involved. Parent of the injured child was contacted and interviewed.
Based on the information that were gathered through observation of the playground and equipment (site where incident occurred), interviews of parent (of child involved), co-teacher, site supervisor, it revealed that on the day of the incident, there were 117 children being supervised by 16 staff members. Per interview, staff members stated that the child was playing on the structure, lost his balance, and hit one of the poles before a staff member was able to assist the child.
The child was taken by parent to the Urgent care and sustained small facial laceration on the left eyebrow and maxillary area. A physician’s note was obtained prior to child returning to school.
At this time, based on the available information obtained, it does not appear that this incident was a result of a Title 22 violation for lack of care and supervision.
An exit interview was conducted with Ms. Coates; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISOR'S NAME: Maureen NealTELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Miriam CohenTELEPHONE: (424) 301-3058
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2022
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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