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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191501069
Report Date: 04/25/2023
Date Signed: 04/25/2023 11:22:04 AM


Document Has Been Signed on 04/25/2023 11:22 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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:SAN MARINO COMMUNITY CHURCHFACILITY NUMBER:
191501069
ADMINISTRATOR:JIHAN MOUSSAUDFACILITY TYPE:
850
ADDRESS:1750 VIRGINIA RDTELEPHONE:
(626) 282-4186
CITY:SAN MARINOSTATE: CAZIP CODE:
91108
CAPACITY:75CENSUS: 22DATE:
04/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Jihan MassoudTIME COMPLETED:
11:25 AM
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Licensing Program Analysts (LPAs) Nolan Tcheng and Mary Silva conducted an unannounced annual random inspection. Upon arrival at 8:40am, LPAs met with Director Jihan Massoud. At 8:50am, LPAs were led on a tour of the facility. This is a Preschool program which consists of 5 classrooms. Per licensee, there are currently 89 enrolled in the program. Hours of operation for this facility are 9am-12pm for preschool, 8-9am & 12-3pm for extended care.

Licensing staff observed all required forms/publications to be posted on the wall of the courtyard near the entrance. Snack menus were reviewed to ensure that they are being posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request.

PHYSICAL PLANT: At 8:50pm, LPAs entered and inspected Room 5 (2s/3s): 0 children with 0 staff members, Room 4 (3s/4s): 0 children with 0 staff members, Room 3 (4s): 3 children with 2 staff members, Room 2 (2s): 0 children with 3 staff members, Room 6 (2s): 8 children with 2 staff members. There were also 11 children with 4 staff members on outdoor play area during morning extended care. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. All floors are clean and safe. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids. The facility was observed to be free of flies, other insects and rodents. Sufficient individual storage space for children was observed and each child has a cubby. Drinking water was readily available indoors. At this time, the office is used as an isolation area. A mat is available for an ill child to rest on. First Aid supplies are available and complete in each classroom. Facility has a functioning carbon monoxide detector that meets statutory requirements. Director states there are no weapons, firearms, or bodies of water on the premises. Due to this being a half day program, there is no scheduled rest/nap time. LPAs observed the storage of mats for children to rest on for extended care. REPORT CONTINUES PAGE 1 of 3

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SAN MARINO COMMUNITY CHURCH
FACILITY NUMBER: 191501069
VISIT DATE: 04/25/2023
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At 9:10am, a fire extinguisher was observed. The valve on the required 2A 10BC fire extinguisher indicates fully charged and was serviced on 08/08/2022, as indicated on service tag. Per State Fire Marshall standards, fire extinguishers shall be serviced annually. Restrooms are accessible from each classroom. All toilets, hand washing, and bathing facilities are safe, sanitary and are operating properly. Snacks are provided by the families of the facility. Parents sign up to bring snacks for their child's class each day and provide lunch for their individual child. LPAs observed the storage of emergency snacks for children in care.

At 9:20am, LPAs reviewed the outdoor play area. Outdoor 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 areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is one outside play space called Big Yard with two play structures, swings, sand area, and tricycles. Another outside play space called small yard, has playhouse, slide, climbing and age appropriate equipment. Both outside areas were accessible through classrooms. Drinking water is readily available outdoors.

Teacher-child ratios were observed to be in accordance with Title 22 regulations. Staff names were recorded. All children were observed to be under visual supervision of a teacher during tour. The Licensee is within the conditions, limitations, and capacity specified on the license. All areas were identified on the Facility Sketch were inspected.

FACILITY RECORDS: Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Disaster drills have been conducted at least every six months. Staff files were reviewed for a health screening report and immunizations that meet regulatory requirements. Criminal Record Clearance for adults and verification of CPR/First Aid and health preventative practices documentation was reviewed. The name of the child care center director or fully qualified teacher(s) designated to act in the director's absence is on file. Educational background, training, and/or experience for each staff present are on file and were reviewed. During review of Mandated Reporter Training, LPAs observed 1 of 13 staff files did not have a current Mandated Reporter training. LPAs discussed with Director, the importance of keeping track of the dates and planning for renewed training in preparation of the end of 2 years. LPA is providing an Advisory Note. A random sample of Children’s Records were reviewed to ensure that they are complete. During review of medication for children, LPAs observed that medication stored had an expiration date that has passed as of 02/2023. LPAs discussed with Director the requirement to have medication stored with a current expiration date. REPORT CONTINUES PAGE 2 of 3

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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
L.A. DAY CARE-EAST, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: SAN MARINO COMMUNITY CHURCH
FACILITY NUMBER: 191501069
VISIT DATE: 04/25/2023
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INCIDENTAL MEDICAL SERVICES:
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations 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 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

Licensee 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.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process

LPA advised the licensee how to access forms, regulations and quarterly updates on line at: www.ccld.ca.gov. AB1207 Mandated Child Abuse Reporting – Implementation was discussed with Licensee. Website provided: http://mandatedreporterca.com/

The Notice of Site Visit (LIC 9213) – must remain posted for 30 daysduring the hours of operation after each site visit by a licensing representative.

At this time, the licensee is in compliance with California Title 22 Regulations. Therefore, there are no citations being issued today.

Exit interview was conducted with Director Jihan Massoud at 11:15am. Copy of report provided.

END OF REPORT PAGE 3 of 3

SUPERVISOR'S NAME: Claudia GuangorenaTELEPHONE: (323) -98-3391
LICENSING EVALUATOR NAME: Nolan TchengTELEPHONE: (323) 240-6201
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 5