Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607580
Report Date: 11/18/2016
Date Signed: 11/18/2016 12:51:57 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
FACILITY NAME:SANTA MONICA-MALIBU USD/MCKINLEY H.S./S.P.FACILITY NUMBER:
191607580
ADMINISTRATOR:KIMBERLY KERNFACILITY TYPE:
850
ADDRESS:2401 SANTA MONICA BLVD.TELEPHONE:
(310) 828-3010
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY:73CENSUS: 37DATE:
11/18/2016
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Reham Dabash, Assistant DirectorTIME COMPLETED:
01:15 PM
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The Licensing Program Analyst (LPA), Tiffanie Tran, conducted a case management incident which occurred on October 06/2016. LPA met with Reham Dabash, Assistant Director and toured the facility inside and outside. LPA reviewed child file and obtained child document as well as the facility roster. Children, staff and other members were interviewed.

According to the report stated, during transition from hand-washing and lunch. The sub teacher was taking hold of child#1 hands/wrists and insisted child to apologize for the way she behaved. Based on the facts presented and the information gathered on the interviews, child #1 had difficult time following the classroom routine. During meal time, child #1 refused to have lunch with the class and decided to jump on the cots. The sub teacher was trying to prevent child from hurting or falling off the cots by hold her by the wrists. Child #1 showed no sign of discomfort or harm during the interaction with the sub.

At this time based on the available information, it does not appear this incident was the result of a Title 22 violation.
No deficiency was cited.

The content of this report was read and discussed in detail at the time of with the noted contact person.

An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.




SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: 310-337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2016
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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