Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197408577
Report Date: 03/28/2019
Date Signed: 03/28/2019 10:02:48 AM

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: 12DATE:
03/28/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Dr. Susan Samarge-PowellTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Christopher Garlington conducted a Case Management Incident inspection to follow up on the self-reported Unusual Incident that occurred at the facility on 01/28/2019. LPA Garlington met with Dr. Susan Samarge-Powell facility Director.

Upon arrival, LPA observed 12 children in care with 1 teacher and 2 assistants providing care. Staff were observed providing proper care and supervision. The facility met capacity an ratio limits. All center staff are fingerprint cleared and associated to the designated license number.

Based on the information provided through interview and observation LPA Garlington has determined that proper reporting procedure was followed. All children affected by the illness outbreak have returned to class with medical clearance and no further incidents have occurred. To mitigate the outbreak facility maintenance staff performed multiple targeted deep cleanings and sanitizing of the facility. Periodic wipe downs of facility surfaces and equipment have also been accomplished.

The content of this report was read and discussed in detail at the time of with the facility administrator.

An exit interview was conducted and the Notice of Site visit was provided.
SUPERVISOR'S NAME: Sharalyn Jenkins-SweetenTELEPHONE: (424) 301-3054
LICENSING EVALUATOR NAME: Christopher GarlingtonTELEPHONE: (424) 301-3056
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2019
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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