Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408577
Report Date: 10/23/2018
Date Signed: 10/23/2018 03:38:07 PM

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/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: 32DATE:
10/23/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Reham Dabash, Assistant DirectorTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Tiffanie Tran conducted a Case Management Incident inspection to follow up on the self-reported incident that occurred at Washington West Head Start on 09/25/18. The El Segundo Regional Office received the incident report on 09/25/18. Upon arrival, LPA observed children were nappiing. Staff provided proper care and supervision and ratio during naptime. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number.
Based on the information that were gathered through interview and observation, it revealed that, on the day of the incident, there were 15 children with 2 teachers and a volunteer. During PM outdoor time staffs observed children were playing cooperatively with wooden blocks. Then for no reason, staff observed a peer hit C1 on the forehead with a wooden block. C1 sustained a small cut on the left side of the head. Staff applied first aid and parents were contacted. Medical attention required. C1 missed two days of school, no restriction upon returning to school. After the incident, staff remind and reinforce the safety rules with the children. Staff discussed with children the proper way to handle the materials. At this time based on the available information it does not appear this incident was the result of a Title 22 violation.

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: (424) 302-3048
LICENSING EVALUATOR NAME: Tiffanie TranTELEPHONE: (424) 301-3053
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2018
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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