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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197494840
Report Date: 05/22/2024
Date Signed: 06/18/2024 10:53:51 AM

Document Has Been Signed on 06/18/2024 10:53 AM - 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 NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME:CHILDREN'S COURTYARD, THEFACILITY NUMBER:
197494840
ADMINISTRATOR/
DIRECTOR:		ERENDIDA ROMEROFACILITY TYPE:
850
ADDRESS:13562-13548 VENTURA BLVDTELEPHONE:
(818) 783-2930
CITY:SHERMAN OAKSSTATE: CAZIP CODE:
91423
CAPACITY: 138TOTAL ENROLLED CHILDREN: 102CENSUS: 67DATE:
05/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:08 PM
MET WITH:Vino Veerasingam and ERENDIDA ROMEROTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On 5/22/2024, Licensing Program Analyst (LPA) Suzette Ornelas conducted a case management visit at facility mentioned above for the purpose of investigating the incident that occurred at the facility on 5/9/2024. LPA met with Assistant Director, Vino Veerasingam and toured the facility indoor and outdoor.

During this visit, LPA observed 67 children being supervised by 12 staff.
LPA made observations, conducted interviews and obtained pictures of the area where the incident occurred.

The Department received the Unusual Incident Report via phone call on 5/9/2024. According to the report, on 5/8/2024, at approximately 4:20PM, Child 1 (C1) fell off playground structure, hit their head and began to bleed. C1 was taken to the office, and Staff 1 (S1) provided first aid by cleaning the wound and kept C1 comfortable until parents arrived. According to S1, the platform has stairs, bridges and a slide. Staff is not sure if C1 bumped their head on the beam or flooring of platform. Platform has coding but is not padded. According to S1, parents stated that C1 got stitches and returned to school on 5/9/24. C1 returned to normal activity upon return to school, staff continued to monitor C1 closely.

Based on the sign in/out sheets, at the time the incident occurred there were two staff present in the yard supervising 14 students.

According to the Director and Assistant Director the plan to ensure that the metal posts do not cause any further serious injuries is to install soft padding around the posts in the play yard. Once the soft padding is installed, pictures will be provided to LPA via email. (Depending on how long the process takes it can take up to a few weeks.)

An exit interview was conducted and a copy of this report and Notice of Site Visit were provided to Assistant Director, Vino Veerasingam and Director, ERENDIDA ROMERO.
SUPERVISORS NAME: Raul Navarro
LICENSING EVALUATOR NAME: Suzette Ornelas
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2024
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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