Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197408577
Report Date: 03/16/2017
Date Signed: 03/16/2017 12:22:16 PM


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 6167 BRISTOL PARKWAY #400
CULVER CITY, CA 90230
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2017 and conducted by Evaluator Trevino Cochran
PUBLIC
COMPLAINT CONTROL NUMBER: 30-CC-20170310125411
FACILITY NAME:SANTA MONICA-MALIBU USD/WASHINGTON WEST H.S./S.P.FACILITY NUMBER:
197408577
ADMINISTRATOR:ALICE CHUNGFACILITY TYPE:
850
ADDRESS:2802 4TH STREET, ROOM 2TELEPHONE:
(310) 399-5865
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:71CENSUS: 48DATE:
03/16/2017
UNANNOUNCEDTIME BEGAN:
09:23 AM
MET WITH:Reham Dabash/Assistant DirectorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Physical Plant-Facility failed to provided a safe environment for the children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Trevino Cochran conducted an un announced complaint visit to investigate the above allegation. LPA met with Reham Dabash, Assistant Director.
Based on the information investigated through LPA observations during visit, reports obtained and interviews conducted, it is revealed that the allegation of Physical Plant/Safe Environment, is Substantiated. LPA observed during complaint visit on 3/16/2017 that the facilities playground has an inoperable sink that was used for water play accessible to children, resulting in a child injuring himself (3/8/2017)and needing medical attention. Therefore, these allegations have been determined to be Substantiated based on the preponderance of the evidence standard has been met.

Facility was cited type B deficiency. Please see Complaint Investigation Report LIC 9099D for deficiency cited. An exit interview was conducted with the assistant director, and a notice of site visit was provided along with the appeal rights.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 30-CC-20170310125411

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
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/WASHINGTON WEST H.S./S.P.
FACILITY NUMBER: 197408577
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/16/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/16/2017
Section Cited
101238(a)
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Buildings and Grounds. The child care center shall be safe, and in good repair at all times.
LPA observed inoperable sink used for water play on the playground accessible to children and resulted in a child injury.
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Assistant Director had toys removed and play area roped off until sink is removed or water feature is protected. LPA observed toys removed and area roped off. Water play area will be off limits until corrections are made and Licensing approves corrections made.
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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: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2017
LIC9099 (FAS) - (06/04)
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