Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191607580
Report Date: 11/07/2019
Date Signed: 11/07/2019 11:42:06 AM

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: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: 39DATE:
11/07/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Reham Dabash, Assistant DirectorTIME COMPLETED:
12:00 PM
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On 11/07/2019, Licensing Program Analyst (LPA) Sabrina Martinez arrived at Santa Monica-Malibu USD/Mckinley Head Start State Preschool for the purpose of following up on the unusual incident that occurred at the facility on 10/16/2019. The unusual incident was reported via phone call on 10/17/2019 and the Unusual Incident Report (UIR) was received by the El Segundo Regional Office via fax on 10/18/2019. LPA met with Reham Dabash, Assistant Director, and discussed the purpose of the visit.

According to the Unusual Incident Report (UIR), on 10/16/2019 at 09:40 am, during outdoor play time, child#1 was running and fell near the orange structure. The child fell on the asphalt between the fence area and pour in place/rubber surface. The child sustained a small cut (about 1/2 inch) on right side of head above the ear. First aid was administered by staff#1 and staff#2. The child's mother was called to notify her of the accident. The mother stated that the child's grandmother would pick up the child from school and take the child home. The child was taken to the doctor by the mother where child received 3 staples on 10/17/2019 to close the cut. The child was advised to return to school on 10/21/2019.

During this inspection, LPA conducted an interview with Ms. Dabash, facility staff, child's parent and the child involved in the incident. LPA also toured the location of where the incident occurred. LPA also obtained a copy of the facility sign in and sign out sheet dated 10/16/2019 as well as the medical clearance for child#1. Based on the information gathered throughout the course of the investigation, it does not appear that this incident was a result of a Title 22 violation. The mother of the child was immediately notified and sought medical assistance on the day of the incident. The child remains enrolled in the above facility. Both teachers, the child and child’s parent statements were consistent. LPA concluded that that at the time of the incident there was adequate supervision and no hazards were found in the playground that may have contributed to the child’s fall. The facility followed proper emergency protocol. No deficiency shall be cited today. An exit interview was conducted and a copy of this report was provided to Reham Dabash, Assistant Director.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Sabrina MartinezTELEPHONE: (424) 301-3059
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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