191606626-4-5-2023-54-CC-TTRN-CQLQ2Y-20230405114755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191606626
Report Date: 04/05/2023
Date Signed: 04/05/2023 11:48:00 AM

Document Has Been Signed on 04/05/2023 11:48 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
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	MELBOURNE HEAD START/STATE PRESCHOOL		FACILITY NUMBER:	191606626
ADMINISTRATOR:	ISABEL DELGADILLO		FACILITY TYPE:	850
ADDRESS:	21314 CLARETTA		TELEPHONE:	(562) 229-7931
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90715
CAPACITY:	37	CENSUS: 31	DATE:	04/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Karen Estella and Cynthia Santos		TIME COMPLETED:	12:10 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	About 9:20AM. Licensing Program Analyst (LPA), T. Tran arrived at Melbourne Head Start to conduct a Annual Required visit. Upon arrival, LPA observed the consolidated Covid-19 CHHS postings and health screening station. About 9:30AM, LPA met with Teacher Karen Estella and toured the facility inside and outside. All center staff that was present during today’s inspection had fingerprint cleared and associated to the designated license number. About 11:50AM Cynthia Santos, Child Development Coordinator arrived to the site. This is a Preschool located on the Elementary school premises. Facility hours of operation are 8:45am - 2:45pm Monday - Friday. There is no extended care offered. LPA observed all posting requirements for operation on the posting board LIC 203A-License, LIC 610 A-Emergency Disaster Plan, LIC 9148-Earthquake Preparedness Check List, PUB 394-Notification of parent’s rights poster, LIC 613A- Personal Rights, PUB 269- Child Car Seat Law, Menus, and Activity Schedule. Children Records were reviewed for completeness. LPA observed current CPR and First Aid Certification for all center staff. Staff records located at the main office, LPA will arrange another visit for files review. Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children napping equipment met the requirement regulation. Storage for children's belongings, bathrooms facilities, and isolation areas were inspected. Children drinking water was observed. First Aid supplies were inventoried. A review of medication policy, including administering, labeling, storage, and records was made. Per staff, no children required medication at this time. Documentation of current Fire & Earthquake drill was observed. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.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

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK S WEST, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MELBOURNE HEAD START/STATE PRESCHOOL	FACILITY NUMBER: 191606626
	VISIT DATE: 04/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Snack/lunch menus were posted. Food, snacks and lunches are delivered daily to the site from the Elementary school cafeteria. Food and snack items are properly stored. Food preparation area was toured for safety, cleanliness and proper equipment.
Outdoor play area observed. Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water.
LPA discussed criminal records/child abuse index clearances & exemptions, child abuse reporting requirements, required licensing forms, capacity limitations, inspection authority, sign-in/sign-out log importance, incident/medication documentation, reporting requirements, licensee appeal/procedure rights & agency's consultative role.
LPA recommended facility to stay updated with information related to Covid-19 from the California Department of Public Health (CDPH) guidelines, including Centers for Disease Control and Prevention (CDC) guidelines to help prevent and protect staff and children in care. LPA advised to read the Child Care quarterly updates every season as the come out to stay informed of any changes or updates to the regulations and PINs. LPA informed the Child Care Advocate Program (CCAP) provide many other helpful resources to the licensees and the public. Visit www.cdss.ca.gov to receive important updates.
LPA informed of released PIN 21-15 CCLD related to Kidde Trusense Smoke & combination Smoke/Carbon
LPA informed the effects of lead exposure for children between ages 1-6 years old are the most at risk for lead poisoning. A copy of lead exposure was provided.
Facility was informed of responsibility to report suspected Child Abuse by calling the Child Abuse Hotline at 1-800-540-4000. Also call the Community Care Licensing office and follow up with a written Unusual Incident/Injury Report (LIC 624B). Facility is reminded that smoking is prohibited on the premises.
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. Facility representative 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.
No deficiency was cited at this time. A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the facility representative, Cynthia Santos

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Tiffanie Tran	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2