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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494730
Report Date: 08/12/2022
Date Signed: 08/14/2022 09:44:24 PM

Document Has Been Signed on 08/14/2022 09:44 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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:SHEPHERD'S FOLD PRESCHOOL - GARDENAFACILITY NUMBER:
197494730
ADMINISTRATOR:INGERSOLL, TROY PAULFACILITY TYPE:
850
ADDRESS:1409 W. 182ND STREETTELEPHONE:
(310) 324-9736
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 1DATE:
08/12/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Licensee Troy Ingersoll and Teacher Pauline HarrisTIME COMPLETED:
06:00 PM
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On 8/12/22, Licensing Program Analyst (LPA), V. Wheatley conducted a case management inspection regarding an injury that occurred to Child #1 on July 14, 2022. The incident was reported to the Department in a timely manner by the director.

LPA was greeted by Teacher Pauline Harris who telephoned the director Laura Chasco. Ms. Chasco has left for the day and unable to come back to the facility. Ms. Chasco called the licensee Mr. Ingersoll to come assist with the inspection.

LPA reviewed the child's file and interviewed staff. The child was playing on the playground and supervised by the director. The director states she assisted the child up the blue climber to go down the slide. The child came off the slide and fell onto the cushion. The child sustained an injury to the wrist/arm. The child was provided first aid treatment by staff. The parents were called immediately and picked up the child. The child was taken to urgent care and was diagnosed with a fracture. The child returned to the facility the following week with a doctor's note for limitations. As of right now, additional information is necessary to complete the investigation.

Exit interview. A copy of the report will be provided.
SUPERVISORS NAME: Maureen Neal
LICENSING EVALUATOR NAME: Veronica Wheatley
LICENSING EVALUATOR SIGNATURE: DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2022
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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