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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191224312
Report Date: 06/08/2022
Date Signed: 06/08/2022 05:34:34 PM


Document Has Been Signed on 06/08/2022 05:34 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:31ST DISTRICT PTSA CREATIVE KIDS-LORNE STREET ELEMFACILITY NUMBER:
191224312
ADMINISTRATOR:ISIS KRIKAVAFACILITY TYPE:
840
ADDRESS:17440 LORNE ST.TELEPHONE:
(818) 609-8946
CITY:NORTHRIDGESTATE: CAZIP CODE:
91325
CAPACITY:72CENSUS: 22DATE:
06/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Maria Olandez, DirectorTIME COMPLETED:
05:40 PM
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On 06/08/22 Licensing Program Analyst (LPA) Silva Garibyan, conducted an unannounced Required - 1 Year Inspection for the school age license. LPA met with Maria Olandez, Director and toured the facility indoors and outdoors. This program is held on Lorne Street Elementary site. The facility utilizes two bungalow type classrooms ( #33 and #34). Kindergarteners are picked up from their classrooms by facility staff and escorted to the rooms 33 and 34. Children in grades First through Fifth arrive directly at the classrooms. Staff sign children in and parents sign them out upon pick up. The director states the children have access to their designated areas only. They do not commingle with the regular school kids. The facility is open Monday to Friday 6:30AM to 8:00 AM and 1:00 PM to 6:30 PM.. A review of the sign in/out sheet was conducted to verify the current census of children. Currently there are 22 children present. Facility is operating within capacity limitations. 2 teachers are present. A record of teacher's names was checked against current facility roster, Staff are currently associated to the facility. Classroom was found to be clean and free from any potential hazards. Children use the bathrooms located on campus and are taken in groups. The bathroom areas were inspected. Bathrooms are separate for boys/girls. Toilets flush properly. Each restroom has adequate toilet paper and paper towels available. Bathrooms were found to be clean. There is adequate lighting/ventilation in the bathroom areas. LPA observed sufficient food to meet the needs of the children, stored in room 34. Director states they buy food every two weeks. There is a refrigerator, sink for food preparation and food storage in this room. The chemicals are kept separate from the food.
SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022
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: 31ST DISTRICT PTSA CREATIVE KIDS-LORNE STREET ELEM
FACILITY NUMBER: 191224312
VISIT DATE: 06/08/2022
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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 and equipment are in good condition, free of sharp, loose or pointed parts. All materials and surfaces accessible to children are toxic free.

All toilets and hand-washing facilities are in safe and sanitary operating condition. All 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. Contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors ( water dispenser) and outdoors (water fountain). 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. Areas around high climbing equipment, swings and slides have cushioning material 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. The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors. The Department has inspection authority as specified in Health & Safety Code. 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. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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: 31ST DISTRICT PTSA CREATIVE KIDS-LORNE STREET ELEM
FACILITY NUMBER: 191224312
VISIT DATE: 06/08/2022
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 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 off site activities. The name of the child care center director or fully qualified teachers 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 personnel, including the licensee, administrator and volunteers, shall be in good health and are physically and mentally capable of performing assigned task. Personnel that pose a threat to the health and safety of children shall be relieved of their duties.

All personnel are trained on housekeeping and sanitation principles, including universal health precautions or have related experience. 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 14 children in care. The licensee ensures children with obvious symptoms related to fever or vomiting are not accepted. The facility is equipped to isolate and care for any child who becomes ill during the day. LPA reviewed a sample of 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 a sample of 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.

Incidental Medical Services (IMS) are / are not currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
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: 31ST DISTRICT PTSA CREATIVE KIDS-LORNE STREET ELEM
FACILITY NUMBER: 191224312
VISIT DATE: 06/08/2022
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by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website linkhttps://www.ada.gov/childqanda.htm.

LPA and Licensee 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, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.


Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (424) 301-3069
LICENSING EVALUATOR NAME: Silva GaribyanTELEPHONE: (424) 301-3062
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4