<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600029
Report Date: 07/24/2024
Date Signed: 07/24/2024 12:44:32 PM

Document Has Been Signed on 07/24/2024 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:ASCENSION LUTHERAN CHURCH DAY NURSERYFACILITY NUMBER:
191600029
ADMINISTRATOR/
DIRECTOR:
JOSE RODRIGUEZFACILITY TYPE:
850
ADDRESS:26231 SILVER SPUR ROADTELEPHONE:
(310) 373-6083
CITY:ROLLING HILLSSTATE: CAZIP CODE:
90275
CAPACITY: 78TOTAL ENROLLED CHILDREN: 78CENSUS: 29DATE:
07/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Jose Rodriguez, DirectorTIME VISIT/
INSPECTION COMPLETED:
01:04 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 07/24/2032 @ 10:45 AM, Licensing Program Analyst (LPA) Miriam Cohen conducted a Case Management Unusual Incident inspection to follow up on the self-reported incident that occurred on 07/16/2024 at Ascension Lutheran Church Day Care Nursery located at 26231 Silver Spur Road, Rolling Hills, CA 90275. The El Segundo Regional Office received the incident report on 07/17/2024. Upon arrival, LPA observed 29 children being supervised by seven staff members. All center staff that was present during today’s inspection had fingerprint clearance and associated to the designated license number.
LPA interviewed the following: Staff member #1 (S1) as the witness and the director (S2). The incident happened towards the end of lunch just before C1 was picked up by parent (half a day schedule). S1 suggested parent to take C1 to Urgent Care. Based on the information that were gathered through interviews, record reviews, and visual inspection of the playground (site of the incident), it revealed that there were three adults supervising 23 children for upstairs classrooms.
According to the narrative provided by S1, the incident took place during lunch (23 children being supervised by three teachers). C1 took her lunch pail to her cubby and instead of returning to her seat, C1 proceeded to climb the tree on the playground. S1 immediately asked C1 to come down and proceeded to inform C1 that the tree is currently off-limits during lunch time. When C1 decided to come down, she fell off the tree and her right elbow hit the ground. While putting ice pack on C1 right elbow, the parent of C1 arrived to pick her up. That evening, the parent informed the school (Bright Wheel App) that C1 sustained a cast on her right arm and will stay at home for the rest of the week. On 07/22/2024, C1 return to school with a cast on her right arm.

During today’s visit, the director barricaded the tree area during eating time and circle time (off limits).
At this time, based on the available information, it does not appear that this incident was the result of a Title 22 violation for lack of care and supervision. There shall be no citation issued today.
The content of this report was read and discussed in detail with Jose Rodriguez, preschool director.
An exit interview was conducted; the notice of site visit must be posted for 30 days upon receipt.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Miriam Cohen
LICENSING EVALUATOR SIGNATURE: DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1