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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191202200
Report Date: 06/07/2022
Date Signed: 06/07/2022 12:52:15 PM


Document Has Been Signed on 06/07/2022 12:52 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:WOODLAND HILLS COMMUNITY CHURCH NURSERYFACILITY NUMBER:
191202200
ADMINISTRATOR:LISA MARLOWFACILITY TYPE:
850
ADDRESS:21338 DUMETZ ROADTELEPHONE:
(818) 887-0704
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91364
CAPACITY:72CENSUS: 56DATE:
06/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Lisa Marlow, Director TIME COMPLETED:
01:00 PM
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On 06/07/2022 8:20AM Licensing Program Analyst (LPA) Denise Miranda, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Lisa Marlow, Director. Facility checklist (LIC 125) provided upon arrival to Director.

Ms. Marlow and LPA toured the facility indoors and outdoors. Days and hours of operation are Monday-Friday 8:AM to 2:00PM. Per Director no children napping during the operation hours, however facility has cots and mats available.

LPA, observed 56 children in care and 13 adults providing supervision and care.

There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible. All poisons are kept in a locked storage area. No poisons were observed during the inspection.

Furniture are in good condition, free of sharp, loose or pointed parts. LPA observed at the classroom#1&#2 with wall heater that needs to be barricade and two air conditioner compressor equipment located at the outdoor (south yard) by the classrooms#3 and #4 needs to be barricade.

Playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAND HILLS COMMUNITY CHURCH NURSERY
FACILITY NUMBER: 191202200
VISIT DATE: 06/07/2022
NARRATIVE
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containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Areas around high climbing equipment, slides have sand to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements. Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption.

Capacity and limitations as specified on the License are being maintained. At least one person trained in CPR and Pediatric First Aid is present when children are at the facility or at offsite activities. The name of the child care center director or fully-qualified teacher(s) designated to act in the director’s absence has been reported to the Department. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care. LPA reviewed a sample of 6 children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed all staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. Menus are posted at least one week in advance where an authorized representative can view them.

Criminal Record Statement

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed.


Regulation and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: WOODLAND HILLS COMMUNITY CHURCH NURSERY
FACILITY NUMBER: 191202200
VISIT DATE: 06/07/2022
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the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

LPA provided a copy of the PIN 22-02 CCP – Best Practice Related to the Provision of Incident Medical Services in Child Care and Family Child Care Homes and PIN – 21-21 Lead Testing of Water in licensed Child Care Per AB2370 and brochure for Effects of Lead Exposure.

LPA and Director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Lead Poisoning Facts, Forms and Regulations.

LPA, Miranda conducted 11:40AM staff interviews during today's visit.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiency is being cited: (see next page, 809 D) Director was provided a copy of their appeal rights.

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

Exit interview conducted and report was reviewed with the Director, Lisa Marlow.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 06/07/2022 12:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: WOODLAND HILLS COMMUNITY CHURCH NURSERY
FACILITY NUMBER: 191202200

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101239(r)
Fixtures, Furniture, Equipment and Supplies
(r) Fixtures, furniture, and equipment that have been banned or recalled by the United States Consumer Product Safety Commission shall not be used or on the facility’s premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview), the Facility did not comply with the section cited above in faciltiy has two wall hearter (classroom#1 and #2) that was observed with no barricade and LPA observed at the South Yard two Air Conditioner compressor with no barricade or make inacessible to the chilren in care which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/21/2022
Plan of Correction
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Director agreed to submit photos of the proper barricade for the two wall heaters located on the classroom#1 and #2 or provide document/seal from gas company that two wall hearters were out of service/off. Also, Director will provide photos from the two air conditioner compressor with proper barricade .Director will submit the photos to LPA Miranda via email no later than 6/21/22.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3068
LICENSING EVALUATOR SIGNATURE:
DATE: 06/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/07/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4