Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408577
Report Date: 04/24/2017
Date Signed: 04/24/2017 10:43:45 AM

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/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: 51DATE:
04/24/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Reham Dabash/Assistant DirectorTIME COMPLETED:
10:46 AM
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Licensing program analyst (LPA) Trevino Cochran arrived at the facility to conduct a Plan of Correction visit for the following deficiencies below, cited during the Complaint Investigation on 3/16/2017.

1)Building and Grounds. LPA observed inoperable sink used for water play on the playground accessible to children in care.

LPA met with Assistant Director, Reham Dabash, who provided LPA with a tour of the preschool to observe the corrections. LPA observed the Director and 10 teachers supervising 51 children. LPA observed sink removed from the wall and area free from hazards and accessible to children. These deficiencies have been corrected and cleared.


This report must be posted for 30 days from today,
This report was read, discussed, and signed during this visit by assistant director.

Exit interview conducted.
SUPERVISOR'S NAME: Sharon GreeneTELEPHONE: (310) 337-4313
LICENSING EVALUATOR NAME: Trevino CochranTELEPHONE: (310) 337-4335
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2017
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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