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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191600684
Report Date: 07/12/2024
Date Signed: 07/12/2024 02:32:24 PM

Document Has Been Signed on 07/12/2024 02:32 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:FIRST LUTHERAN CIRCLE OF LOVE PRESCHOOLFACILITY NUMBER:
191600684
ADMINISTRATOR/
DIRECTOR:		NANCY J. DURKOVICFACILITY TYPE:
850
ADDRESS:1100 POINSETTIA AVE.TELEPHONE:
(310) 545-5653
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY: 125TOTAL ENROLLED CHILDREN: 125CENSUS: 33DATE:
07/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:APRIL LANG, SUPPORT STAFFTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 7/12/2024, Licensing Program Analyst Loyce Phillips conducted a case management inspection to follow up on an Unusual Incident, reported to the department by telephone on 5/17/2024. LPA was greeted by Support Staff, April Lang. LPA took a census of the children present today. LPA observed 33 children present with 7 staff members.

Description of the incident: On 5/16/2024 at approximately 2:45pm. C1 was running on the padded ground and fell down and scratched his leg/knee area. C1 complained that his arm was hurting. First aid was applied to legs and his arm was wrapped. Parent was called and arrived to the facility within 4 minutes. Staff assisted C1 to the car. Parent transported C1 to urgent care, where child needed to follow-up at the Orthopaedic Institute for Children. Child's left arm sustain a fractured elbow and broken wrist. C1 has returned back to the facility on 5/20/2024 with restrictions.

Based on the information obtained, interviews conducted and LPA's observation of the play yard area. C1 accidentally fell into the sand and sustain a fractured elbow and broken wrist. The facility had appropriate children/staff ratios during the incident, there were no equipment or objects on the play yard where child fell and the facility reported the unusual incident in a timely manner; therefore, no Title 22 violations have occurred, and no deficiencies cited.

A notice of site visit was given and posted for 30 days.

Exit interview conducted and report was reviewed with April Lang.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Loyce Phillips
LICENSING EVALUATOR SIGNATURE: DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/27/2024
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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