Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191671677
Report Date: 06/15/2017
Date Signed: 06/15/2017 02:19:28 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:GROWING PLACE, THEFACILITY NUMBER:
191671677
ADMINISTRATOR:ANITA DE LA PUENTEFACILITY TYPE:
850
ADDRESS:401 ASHLAND BTELEPHONE:
(310) 399-7760
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:86CENSUS: 74DATE:
06/15/2017
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Anita De La Puente, DirectorTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA), Tiffanie Tran conducted a Case Management Inspection to follow up on the self-reported incident that occurred at The Growing Place on 5/12/17. The Culver City Child Care Office received the incident report on 5/16/17 by Anita De La Puente, Director. Reporter stated, child # 1 was playing on the grass area with the croquette game. His brother was playing in front of him. Child's #1 brother swung the croquette stick and accidentally hit him of the side of the head. Child sustained a minor cut which required staples. Medical attention was required. Parent was contacted immediately.

Per staff stated, on the day of the incident there were 2 teachers and 16 children. LPA observed the toy material to be age appropriate. Staff observed the incident and assisted the child properly. Based through the course of interviewed, observation and the available information it does not appear this incident was the result of a Title 22 violation for lack of care and supervision. Therefore, no deficiency was cited for today's visit.

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: 06/15/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2017
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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