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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197418428
Report Date: 09/23/2024
Date Signed: 09/23/2024 08:54:42 PM

Document Has Been Signed on 09/23/2024 08:54 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:PLAYA VISTA-STARFACILITY NUMBER:
197418428
ADMINISTRATOR/
DIRECTOR:		MONTGOMERY, JULIEFACILITY TYPE:
840
ADDRESS:13150 BLUFF CREEK DR.TELEPHONE:
(310) 678-8298
CITY:PLAYA VISTASTATE: CAZIP CODE:
90094
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 73DATE:
09/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:42 PM
MET WITH:Daren HiltunenTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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On 9/23/24 Licensing Program Analyst (LPA) Ranita Richmond arrived at the above named facility to conduct an unannounced case management incident visit due to unusual incident report (UIR) received via email to On Duty worker on 9/16/24. LPA was greeted by associate director, Daren Hiltunen.

LPA toured the facility both indoors and outdoors. LPA observed 73 children and 8 staff members providing care and supervision.

Facility contacted the On Duty worker on 9/16/2024 to report an unusual incident that occurred at the facility on 9/10/2024. Unusual incident report submitted to the El Segundo Child Care Regional Office states that child was sitting on the concrete barrier around the dirt area when he fell to


the ground and started to cry. The teacher (C. Jones), moved closer to C1 to
check and see if he was injured. He asked C1 where he was hurting, as well as
inspected him visually for signs of injury. C1 did not say if any specific area was hurting
but he continued to cry. The teacher did not see any marks or abrasions on C1 at this
time and sat with C1 for a while until he stopped crying.

The day of the incident, director confirmed that 1 staff member was outside in the yard providing care and supervision to 11 children.

During today’s inspection, LPA observed the outdoor space, the equipment that children were using during the incident and the placement of each teacher in the yard. LPA interviewed staff named in the incident report.
SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE: DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO CC RO, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: PLAYA VISTA-STAR
FACILITY NUMBER: 197418428
VISIT DATE: 09/23/2024
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Per Associate Director, Mom disenrolled child from the star program on 9/11/24.

Associate Director provided LPA contact info for C1 and parent.

There were no citations issued during today’s inspection. The Unusual Incident Report investigation will continue.

An exit interview was conducted. A copy of this report and Notice of Site Visit was provided to facility associate director Daren Hiltunen.

SUPERVISORS NAME: Claudia Escobedo
LICENSING EVALUATOR NAME: Ranita Richmond
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2024
LIC809 (FAS) - (06/04)
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