Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408577
Report Date: 02/15/2018
Date Signed: 02/15/2018 04:15:19 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/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: 35DATE:
02/15/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Reham Dabash, Assistant DirectorTIME COMPLETED:
04:30 PM
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The Licensing Program Analyst (LPA), Tiffanie Tran conducted a site inspection to follow up on an incident case management which occurred on 09/26/2017. LPA met with Reham Dabash, Assistant Director. Upon arrival, LPA observed children were napping. LPA observed proper care and supervision.
Per assistant director, they have any knowledge of the information was emailed to them on 11/29/17. The facility contacted the department and reported the incident on 12/4/17. Based on the report LAUP assessor came to the facility on 9/26/17 to conduct a CLASS observation. Per observation notes, classroom staff physically moved a child from a rug area to a chair. And another staff held a child in a chair.

LPA interviewed staffs and obtained a copy of the observation report.

Based on the information obtained, further review is required.

An exit interview was conducted. A copy of this report and Notice of Site Visit were provided.

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

DATE: 02/15/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2018
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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