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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191609574
Report Date: 06/28/2023
Date Signed: 06/28/2023 04:17:13 PM

Document Has Been Signed on 06/28/2023 04:17 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:CHILDREN COMMUNITY ACADEMYFACILITY NUMBER:
191609574
ADMINISTRATOR:ETHEL L. HENSONFACILITY TYPE:
850
ADDRESS:4729 W. SLAUSON AVE.TELEPHONE:
(323) 290-0022
CITY:LOS ANGELESSTATE: CAZIP CODE:
90056
CAPACITY: 90TOTAL ENROLLED CHILDREN: 47CENSUS: 33DATE:
06/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Henson, LicenseeTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Shandra Powell conducted an unannounced Required 1 year inspection on 06/28/2023. A Risk Assessment for COVID-19 was completed. LPA met with Ethel Henson, Director and Pamela Calvert, Assistant. A copy of the Entrance Checklist for Child Care Centers form (LIC 126) was provided to Assistant during inspection. LPA identified self and the nature of the inspection. LPA toured the facility upon arrival. This is a preschool program which consists of 5 classrooms: only 4 classrooms were in use during inspection. The facility operates from 6:00am to 6:00pm Monday thru Friday.

All areas identified on this report were inspected. The facility was observed to be within the license capacity and limitations. LPA observed 33 children in care during inspection. The following was observed during the tour of the facility:

LPA observed on the bulletin board, Parents Right's, Personal Rights, LIC 610 Emergency Disaster Plan, Facility Sketch, LIC 9148 Earthquake Checklist, PUB 269 Child Passenger System Poster, monthly Menu and Daily Schedule. LPA observed the sign in/out sheets signatures (electronically inputted on Bright wheel) at entrance of facility. Staff printed check in log LPA observed the signatures to be consistent with the number of children present.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting, and ventilation were evaluated.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2023
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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Document Has Been Signed on 06/28/2023 04:17 PM - It Cannot Be Edited


Created By: Shandra Powell On 06/28/2023 at 11:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

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 [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/07/2023
Plan of Correction
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Licensee will complete all paperwork for testing water for lead and send a copy of forms to LPA by POC date of 07/07/2023 via email.
Type B
Section Cited
HSC
1596.8662(c)
Administration of Child Day Care Licensing
(c) Current proof of completion for each licensed child day care provider or applicant for that license, administrator, and employee of a licensed child day care facility shall be submitted to the department upon inspection of the child day care or upon request by the department.

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 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/03/2023
Plan of Correction
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Licensee will have all staff complete Mandated Reporter Training and will email a copy of each staff certificate to LPA by POC 07/03/2023.
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 Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/28/2023 04:17 PM - It Cannot Be Edited


Created By: Shandra Powell On 06/28/2023 at 11:56 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101216.2(e)
Teacher Aide Qualifications and Duties
(e) An aide shall work only under the direct supervision of a teacher.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/28/2023
Plan of Correction
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Licensee will meet with the all Staff and No aide will be left alone with children only during nap time.
Declaration completed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Starks
LICENSING EVALUATOR NAME:Shandra Powell
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2023


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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: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574
VISIT DATE: 06/28/2023
NARRATIVE
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Children have their own cubby to store their belongings. Children at this facility nap on mats in their classrooms. Per Director, the isolation area is in the computer room. Age-appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Linens are taken home each week to be washed. Availability of indoor and outdoor drinking water was observed in classrooms.

Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children. Assistant states that there are no poisons stored at the facility. Carbon monoxide detectors were observed and tested to ensure that they are operable.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. 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 or solid waste bags shall be discarded immediately after each meal.

Outdoor playground equipment is in a 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, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed.

All floors were observed to be clean and safe. All materials accessible to children were observed to be toxic-free There are no firearms stored on the premises. There are no pools or bodies of water at the facility.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574
VISIT DATE: 06/28/2023
NARRATIVE
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There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed for completeness; Inspection of required forms was made and documented on the LIC 857.

LPA also reviewed staff records. The review of Staff records was document on the LIC 859. Staff present did not have proof of the AB 1207 Mandated Reporter Training certificate on file. www.mandatedreporterca.com

Staff present did have proof against TB, measles, pertussis, and influenza(optional). LPA also observed that staff present did have proof of CPR and Pediatric First Aid certification during the inspection




Children's roster was reviewed, however was not complete and is not current. This poses as a potential health and safety risk to children. LPA requested Roster to be completed and a copy sent to CCLD by 07/06/2023. Digital Sign-In and Sign-Out were reviewed during the inspection. Children present were signed in. Disaster drill log was available, last drill was conducted on 06/06/2023.

Menus were observed to be posted one month in advance and posted where it is visible by the child’s authorized representative. Menus for the past 30 days are available upon request. Food vendor Molding Hearts provides Breakfast and Lunch for children daily and snacks are provided by the facility and or children bring snacks from home. The Facility provides AM and PM snack.

First Aid supplies were observed to be in the office. According to the Assistant, there are no children currently on medication.

Review of records to be maintained LPA reviewed with Assistant the LIC 311A, Records to Be Maintained At The Facility, for child’s records, personnel records, administrative records, and documents to be posted.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574
VISIT DATE: 06/28/2023
NARRATIVE
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Criminal Record Clearance - was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, 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 for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing - Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test. For childcare center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1- CCP). LPA verified that the lead testing was not completed in accordance to the Written Directives outlined in PIN 21-21.1-CCP. LPA referred licensee to the Department website for lead: Lead Toxicity Prevention and Water Testing Information.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02- CCP. 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) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/

MyChildCarePlan.org website; a consumer education website that helps families obtain childcare by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
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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: CHILDREN COMMUNITY ACADEMY
FACILITY NUMBER: 191609574
VISIT DATE: 06/28/2023
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To improve the quality and value of the new inspection process, a survey may 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 CARE tools, please send email inquiries 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/inspection-process

Notice of Site Visit - A notice of site visit was given and must remain posted for 30 days.

Exit Interview - Exit interview conducted and report was reviewed with the Assistant Pamela Calvert.

SUPERVISORS NAME: Karren Starks
LICENSING EVALUATOR NAME: Shandra Powell
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2023
LIC809 (FAS) - (06/04)
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