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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191602514
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:49:42 PM


Document Has Been Signed on 02/01/2024 03:49 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:DER KINDER GARDEN INFANT CENTERFACILITY NUMBER:
191602514
ADMINISTRATOR:JAYASURIYA, TARISHAFACILITY TYPE:
830
ADDRESS:1843 10TH ST.TELEPHONE:
(310) 318-3838
CITY:MANHATTAN BEACHSTATE: CAZIP CODE:
90266
CAPACITY:30CENSUS: 16DATE:
02/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:TARISHA JAYASURIYA, DIRECTORTIME COMPLETED:
12:45 PM
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On 2/1/2024, Licensing Program Analyst (LPA)Loyce Phillips conducted an unannounced Required Year Inspection for the infant license with toddler component. Licensing Program Analyst met with Director, Tarisha Jayasuriya and toured the facility indoors and outdoors. Licensing Program Analyst observed 1 infant classroom with 6 infants and 2 staff. The toddler classroom had 10 toddlers with 3 staff.

The facility is operates Monday through Friday from 7:00am to 5:30pm. 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. 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. Floors in the infant rooms 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 containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. The facility provides bottle water. Areas around high climbing equipment have artificial grass with padding underneath to absorb falls. The facility is free of flies, insects and rodents. Prior to working or volunteering in a licensed childcare 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. 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.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DER KINDER GARDEN INFANT CENTER
FACILITY NUMBER: 191602514
VISIT DATE: 02/01/2024
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All children are under supervision, including visual supervision, of a teacher at all times. There is a ratio of one teacher supervising no more than four infants in care. There is a ratio of one teacher supervising no more than six toddlers. 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 individual feeding plan, infant LPA reviewed a sample of staff files and observed files were complete with health screening. Staff records contain documentation of meeting qualification requirements. The facility has sufficient age-appropriate furniture, and equipment including cribs, cots, changing tables and feeding chairs. There is indoor and outdoor activity space for infants that is physically separate.

Each crib, mat or cot is occupied by only one infant at time and cribs are kept free from all loose articles including blankets and pillows and there are no objects hanging above or attached to the crib. Infants are not swaddled while in care. LPA explained that staff are to physically check on sleeping infants/ toddlers up to the age of 2 every fifteen minutes and documents any signs of distress which includes but is not limited to flushed skin color, increase in body temperature, restlessness and labored breathing. Documentation for infants up to 12 months includes sleeping position if it is other than on their back. Individual Infant Sleeping Plan is completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements are being met while infants are sleeping.

Incidental Medical Services (IMS) are not currently being provided. Director 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 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, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: DER KINDER GARDEN INFANT CENTER
FACILITY NUMBER: 191602514
VISIT DATE: 02/01/2024
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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations deficiencies are cited.

An exit was conducted, a copy of this report was read and provided to Director. This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit was provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 02/01/2024 03:49 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
L.A. DAYCARE-NO.WEST, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245


FACILITY NAME: DER KINDER GARDEN INFANT CENTER
FACILITY NUMBER: 191602514

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216(g)(1)
101216(g)(1)
(1) Except as specified in (3) below, good phyiscal health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervison of a physician not more than one year prior to or seven days after employment or licensure,

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 3 out of 9 employees are missing TB test results in their files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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Employees will obtain a copy of their TB test results by POC date.
Type B
Section Cited
HSC
1597.622(a)(1)
1597.622 Employees or volunteers at family day care home; immunization requirements; records; exemptions

(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 6 out of 9 employees are missing immunizations which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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Employees will obtain a copy of their immunization records and place in files by POC date.
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: Karren StarksTELEPHONE: (310) 740-3038
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4