191671378-6-27-2019-30-CC-HESA-BDJPAU-20190627110921

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191671378
Report Date: 06/27/2019
Date Signed: 06/27/2019 11:09:26 AM

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:	DER KINDERGARDEN PRESCHOOL		FACILITY NUMBER:	191671378
ADMINISTRATOR:	MCCLELLAN, ROSE		FACILITY TYPE:	850
ADDRESS:	1843 10TH. STREET		TELEPHONE:	(310) 318-3838
CITY:	MANHATTAN BEACH	STATE: CA	ZIP CODE:	90266
CAPACITY:	60	CENSUS: 14	DATE:	06/27/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Tarisha Jayasuriya - Director		TIME COMPLETED:	11:20 AM

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	On 6/27/19, Licensing Program Analyst (LPA) Helen Estrella conducted an annual random inspection at the facility. LPA met with Tarisha Jayasuriya, Center Director who guided LPA on a tour of the facility (inside and outside). The facility consists of a combination center. There is an infant component in the rear of the preschool. LPA observed 14 children supervised by 1 teacher and the Director. The preschool consists of 3 classrooms that are in the front of the facility. LPA reviewed sign in/out sheet and verified that all staff has obtained criminal record clearances and were associated to the facility. LPA reviewed the following during the inspection: furniture and equipment appears age appropriate and free of sharp hazards. The facility has several equipped first aid kits and a fully charged 2A10BC fire extinguisher. Heating, lighting, ventilation appears adequate. There is drinking water readily available inside and outside. There is an isolation area for ill children in classroom #1 next to front office. Each classroom has 1 sink and 2 toilets there was sufficient toilet paper and towels available for children in care. The facility provides AM/PM snacks and the Director states parents provide lunch. Each food, snacks and medicine was labeled appropriately. Disinfectants, cleaning supplies are out of children's reach. Food preparation area appears adequately equipped, clean and free of hazards. Mats/playpens observed stored properly and bedding supplies stored individually in children's cubicles. LPA reviewed CPR Pediatric First Aid for staff valid through 05/2020. Last fire drill conducted June 2019. LPA inspected outdoor area and observed climbing structures, slides that are securely anchored and a sandbox in preschool area and toddler area. Drinking water is readily available outside. There are several sections of play equipment in the outdoor yard and the Director states the front of the play yard for preschool children with sandbox is not used at this time due to maintenance. It was observed to be made off limits to children. Staff records reviewed and observed with required licensing documents. The facility does not provide Incidental Medical Services (IMS). There is a child enrolled who requires use of inhaler, however, it was observe the parent instructed she provide the medicine and/or 911 is to be called by the facility. There are no bodies of water present at the facility.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

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
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: DER KINDERGARDEN PRESCHOOL	FACILITY NUMBER: 191671378
	VISIT DATE: 06/27/2019

NARRATIVE

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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.
Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag.

The following was discussed with the facility:
All adults living and working in the home must be fingerprinted and cleared prior to entering the facility. The licensee was informed that the presence of adults in the home without Criminal Record Clearance or Exemption will be cited and civil penalty assessed for $100 per day. The licensee may find additional information and forms on the DSS website at www.ccld.ca.gov including information on the Live Scan application (LIC 9163). Appointments can be made for Live Scan at 1-800-315-4507.

The licensee was informed of the responsibility to report suspected Child Abuse by calling the Child Abuse Hot line at 1-800-540-4000. Also call the CCL office within 24hours of the Unusual Incident and follow up with a written Unusual Incident/Injury Report (LIC 624B) within 7 business days.

The licensee was advised that, once licensed, the Notice of Site Visit must be posted at the entrance of the facility for a period of 30 days. If a serious violation is cited, (Type A violation), a copy of the licensing report (LIC809 or LIC9099) must also be posted for 30 days. If these requirements are not met, civil penalties in the amount of $100 per violation will be assessed. The applicant was made aware that a licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment.

The facility appears to operate within substantial compliance during today's visit. A copy of this report was provided to the facility and exit interview conducted.

SUPERVISOR'S NAME: Jennie Ferreira	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen Estrella	TELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2019

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2019

LIC809 (FAS) - (06/04)

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