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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607580
Report Date: 06/05/2024
Date Signed: 06/05/2024 02:22:27 PM


Document Has Been Signed on 06/05/2024 02:22 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:SANTA MONICA-MALIBU USD/MCKINLEY H.S./S.P.FACILITY NUMBER:
191607580
ADMINISTRATOR:ALICE CHUNGFACILITY TYPE:
850
ADDRESS:2401 SANTA MONICA BLVD.TELEPHONE:
(310) 828-3010
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY:73CENSUS: DATE:
06/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Reham Dabash Assistant DirectorTIME COMPLETED:
03:00 PM
NARRATIVE
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On 06/5/2024 Licensing Prgram Anayst( LPA) Doris Whitmore conducted an unannounced visit for the purpose of conducting a Case Management Inspection due to an incident that occurred and was reported to the Regional Office on 05/13/2024 by the Assistant Director.LPA Whitmore met with Special Ed Teacher at the time of arrival. LPA Whitmore informed about the purpose of the visit. There was a total of 17 children and 4 Staff. The UIR report stated that (S3) ( Para Educator) told ( S2) ( Teacher that ( C1) was found in the sunroom Classroom alone. (S1) escorted the child to the restroom and left ( C1) was The restroom is located in the classroom. The time the incident occurred was during the transition from playtime to restroom, when ( S2)( found ( C1) without assistant. LPA Whitmore interviewed the staff, 1 child, Director and Assistant Director.
LPA obtained a copy of the Daily Transitional Head count from 05/09/2024 and a copy of the Unusual Incident/ Injury Report.
Based on the information obtained throughout the course of the investigation, which included interviews with facility staff and 1 child there was a lack of care and supervision due to child being left by the door by the restroom unattended. (S1) informed (C1) to go outside because she had to use the restroom
LPA Whitmore conducted exit inter view with Reham Dabash, Assistant Director and Susan Samarge- Powell, Director. and explained that the deficiency was a Type A. Please see LIC 809 D.

For Type A Citations- A copy of this report shall be provided to the parent/ guardian of children currently enrolled by the next business day or immediately upon return, A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 month(year) The Acknowledgment form must be maintained in each child's file immediately upon receipt from parent. During this visitThe Director/ Assistant Director was provided with a copy of LIC 9224 Acknowledgement of Licensing Reports. A copy of this report and Notice of Site Visit was issued.




SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
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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Document Has Been Signed on 06/05/2024 02:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: SANTA MONICA-MALIBU USD/MCKINLEY H.S./S.P.
FACILITY NUMBER: 191607580

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time,
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 On 05/16/2024 A Care and Supervision Training where policies and procedures on supervison were discussed. LPA was provided with sign in sheet, agenda. A Transitional Log was created and used for any outdoor to indoor transition. LPA was provided a copy.
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This requirement was not met as evidence because ( C1)was left alone unattended in the classroom
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024
LIC809 (FAS) - (06/04)
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