191228638-9-30-2022-58-CC-SORS-CJRUG5-20220930153347

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191228638
Report Date: 09/30/2022
Date Signed: 09/30/2022 03:34:04 PM

Document Has Been Signed on 09/30/2022 03:34 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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	ST. NICHOLAS SCHOOL		FACILITY NUMBER:	191228638
ADMINISTRATOR:	SARA SKIANI/GEORGIA BACOUL		FACILITY TYPE:	850
ADDRESS:	9501 BALBOA BLVD.		TELEPHONE:	(818) 886-6751
CITY:	NORTHRIDGE	STATE: CA	ZIP CODE:	91325
CAPACITY:	90	CENSUS: 64	DATE:	09/30/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	GEORGIA BACOUL - Director		TIME COMPLETED:	03:40 PM

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On 09/30/2022 Licensing Program Analyst (LPA), Suzette Ornelas conducted an unannounced Annual Required Inspection for the preschool license with the toddler option. LPA met with Director, Georgia Bacoulis and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday 7am to 6p.

LPA observed 64 children and 12 adults. A review of the sign in/out sheet was conducted to verify the current census of children. All children are under supervision, including visual supervision, of a teacher at all times. Capacity and limitations as specified on the license are being maintained. LPA observed 8 licensed preschool classrooms on the premises.

All areas identified on the Facility Sketch were inspected.

RM 10 (3 year olds) : 11 preschool children with a ratio of 2 teachers
RM 9 (3 year olds) : 11 preschool children with a ratio of 2 teachers
RM 8 (pre-K): 12 preschool children with a ratio of 1 teacher
RM 7 (pre-K): 11 preschool children with a ratio of 1 teacher
Room 6: Currently not in use
RM 5 (Toddlers): 4 toddlers with a ratio of 2 teachers
RM 4 (2 year olds): 8 preschool children with a ratio of 2 teachers
Rm 3 (2 year olds): 7 preschool children with a ratio of 2 teachers

A walk through of the classroom room space was conducted, the space was found to be clean and free from any potential hazards.Furniture was found to be in good repair and age appropriate. LPA observed all required postings in a prominent area.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ST. NICHOLAS SCHOOL	FACILITY NUMBER: 191228638
	VISIT DATE: 09/30/2022

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There is adequate heating, lighting and ventilation. Drinking water is readily available. Isolation area for sick students is located in the Main Office. LPA observed adequate arrangements for isolation and care of ill children.

The bathroom and toileting areas were inspected, LPA observed toilets and sinks to accommodate the facility’s capacity. Room 10,5 and 4 are equipped with a restroom. There are 2 additional restrooms in an outdoor area to the right of the Main Office building with designated boys (1 toilet,1 urinal, 1 sink) and girls (2 sinks, 2 toilets) restrooms. Toilets flush properly, toilet and sinks are reachable by the children in care. The restrooms have adequate toilet paper and paper towels available. The bathrooms were found to be clean. There is adequate lighting/ventilation in the bathroom area.

Playground equipment is in safe condition and free of hazards. 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. LPA reminded Director to ensure equipment is dusted off as needed. Per Director, parents provide daily meals for children. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors and provided as needed. The facility is equipped with a working smoke detector, carbon monoxide detectors and fire extinguishers (2A 10BC) in every classroom. 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. No poisons were observed during the inspection.

The facility has sufficient cots or mats for napping. LPA reviewed a sample of children’s files and observed files were complete. 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. 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. LPA reviewed a sample of staff files and observed files were incomplete. 2 staff were missing the LIC503, Director will provide proof of completion to LPA via Email by 10/14/2022. LPA provided Administrator with a copy of the Disaster and Mass Casualty Plan regulation and information on ensuring the plan follows regulating requirements.

SUPERVISOR'S NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

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
EL SEGUNDO CC NORTH, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: ST. NICHOLAS SCHOOL	FACILITY NUMBER: 191228638
	VISIT DATE: 09/30/2022

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LPA reminded director to ensure all emergency supplies are replenished as needed. LPA provided director with infant safe sleep information which applies to toddler under the age of 2 years old. Director immediately printed out the safe sleep logs, regulation, and FAQ's. Director provided the information to the staff to begin infant sleep documentation starting today 09/30/2022. LPA provided director with a coy of the Preschool Program with Toddler Component regulation. Director will obtain written permission from child’s authorized representative and submit proof to LPA via email by 10/14/2022

Incidental Medical Services (IMS) 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 by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://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: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR NAME: Suzette Ornelas	TELEPHONE: 424-301-3008
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2022

LIC809 (FAS) - (06/04)

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