191802294-10-7-2021-54-CC-KCHE-C7KTV4-20211007150320

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802294
Report Date: 10/07/2021
Date Signed: 10/07/2021 03:03:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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

FACILITY NAME:	LUMBINI CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	191802294
ADMINISTRATOR:	NICHO, LESLIE		FACILITY TYPE:	850
ADDRESS:	505 EAST THIRD STREET		TELEPHONE:	(213) 680-2976
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90013
CAPACITY:	60	CENSUS: 19	DATE:	10/07/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Leslie Nicho, Director		TIME COMPLETED:	03:30 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	An unannounced Annual Required Inspection was conducted on 10/07/2021 at 12:15 PM by Licensing Program Analyst (LPA) Katrina Chicote. LPA conducted COVID-19 screening call prior to entering facility. Facility is currently licensed for a capacity of 60. Licensing staff met with Leslie Nicho, Director. The program currently operates Monday thru Friday from 7:30 AM to 6:00 PM. LPA toured the facility both indoors and outdoors. Children were eating lunch and transitioning towards nap time at time of inspection. At the initial start of the site visit, there is a total census of nineteen children and a total census of four teachers present. Telephone service, heating, lighting and ventilation were evaluated, LPA observed mobile A/C units in each classroom. The facility is made up of six classrooms, Room 6 (Kindergarten room), Orange Room (2-3 years old classroom), Red Room (Pre-K classroom), Yellow Room (4 years old classroom), Room 7, which serves as a utility room and isolation area for sick children, and a large All Purpose Room in the center of all the rooms that children use for napping, eating, and indoor play space. Furniture and equipment were inspected for age appropriateness and good repair. LPA observed child appropriate tables and chairs in each classroom, art supplies, play kitchens, bins with plastic cars, plastic animal figures, doll houses, and other age appropriate toys at time of inspection. LPA observed cubbies in each classroom used as storage for children's belongings. Mats/cots were inspected, LPA observed standard blue cots being used for children napping at time of inspection. Per Director, linens are provided by the families and goes home each Friday. Availability of drinking water was reviewed, Director states that at this time children are bringing water bottles from home that are filled through the day, LPA observed children water bottles at time of inspection. LPA observed two restrooms that children use, accessible through door ways next to All Purpose Room. LPA observed each restroom to have three child size toilets and age appropriate sinks were inspected for availability, good repair, water temperature, toilet paper, area safety and sanitation. Report Continues - Page 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 10/07/2021

NARRATIVE

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LPA observed a first aid kit is kept in each classroom. LPA observed carbon monoxide detectors and smoke detectors are present in the facility. Fire extinguishers have been serviced on 06/30/2021. Hazardous items including poisonous cleaning compounds were stored inaccessible to children, LPA observed these items in off limits kitchen area. LPA observed door to kitchen closed at time of inspection making this off limits to children in care. Per Director, children are not allowed in there per health department rules.

Per Director, families bring lunch from home at this time due to COVID-19, though they previously served lunch. Snack/lunch menus were reviewed from March 2020. LPA observed children eating from their lunch boxes in All Purpose Room upon arrival to facility. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. Food preparation areas were toured for safety, cleanliness and proper equipment.

At 12:35 PM, LPA observed outdoor equipment for safety, cushioning material, good repair and age-appropriateness. LPA observed large multi-level play structure with slides to have cushioning material below, plastic play houses, and child size tables and chairs under shaded area. Required shade and fencing were inspected. LPA observed large blocks and other play equipment that were dusty and stored to the side of outdoor play area, per Director these items are currently not being used at this time due to COVID-19 sanitation guidelines. LPA Chicote advised Director that the children need to be within the direct care and supervision, including visual supervision of the teacher(s) at all times. The children have access to drinking water during outside play through their personal water bottles. Play area was inspected for hazards and inaccessibility to bodies of water; no bodies of water or hazards observed.

Teacher-child ratios were observed and staff names recorded. Care and supervision was evaluated to determine if the basic needs of children are met and appropriate. Sign-in and out sheets and procedures were reviewed. Personal Rights of children were observed by LPA.

Staff and Children’s Records were reviewed. Criminal Record Clearances were reviewed for adults. At 2:00 PM, LPA observed CPR card expires on 01/2021 for all staff and Mandated Reporter training completed on 02/14/2019 for all staff, per AB1207 Mandated Reporter training must be completed every two years. Inspection of required forms made.

Report Continues - Page 2

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 10/07/2021

NARRATIVE

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Incidental Medical Services:
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

The following were discussed with the Director:
Rooms that are off-limits need to be made inaccessible during operating hours. Smoking is prohibited.

The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.

The fire extinguisher type 2A-10BC must be serviced annually or as often as necessary. Smoke and Carbon Monoxide detectors should be checked and batteries replaced as needed. Changes should be reported to the Department as soon as they occur such as construction, remodeling, telephone number changes and/or if you move from your location.

Mandatory Forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. The Director was advised how to access forms and Regulations online at www.ccld.ca.gov. Director was made aware that it is his/her responsibility to know the regulations as well as anyone who assists in providing care.

AB 1207: Beginning on January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: http://www.mandatedreporterca.com/www.mandatedreporterca.com

Report Continues - Page 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

Page: 3 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
	VISIT DATE: 10/07/2021

NARRATIVE

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LPA advised Director that all adults 18 years of age and older providing Care & Supervision and/or have continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check.

Based on this information, the following deficiencies on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health & safety.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Leslie Nicho.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

Page: 4 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1596.7995(a)(1)

General Provisions and Definitions

(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center 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
1 2 3 4	Based on LPA record review, all staff (4 of 4) did not have proof of immunization against MMR, TdaP, or a written declination for the influenza vaccine available during today's inspection. This is a potential health, safety, and personal rights risk to children in care.
	POC Due Date: 11/08/2021
	Plan of Correction
1 2 3 4	Director states she will obtain immunization records for staff by POC date and provide proof to LPA via email.

Type B

Section Cited

HSC

1596.8662(b)(1)

Administration of Child Day Care Licensing

(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA record review and interview, LPA did not observe current proof of completion of mandated reporter raining in 4 of 4 staff files (all expired on 02/14/2021); and per Director, they are in need of updating this training. This poses a potential health, safety, and personal rights risk to children in care at time of inspection.
	POC Due Date: 11/08/2021
	Plan of Correction
1 2 3 4	Director states they will complete training and provide proof of completion to LPA by POC date via email.

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

Page: 5 of 10

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: LUMBINI CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 191802294
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/07/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101216(f)

Personnel Requirements

(f) At least one staff member who is trained in pediatric cardiopulmonary resuscitation and pediatric first aid pursuant to Health and Safety Code Section 1596.866 shall be present when children are at the child care center or offsite for center activities. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA record review and interview, 4 of 4 staff members had pediatric First Aid/CPR that expired on 01/2021; and per Director they have not taken updated training for this. This poses a potential health, safety, and personal rights risk to children in care at time of inspection.
	POC Due Date: 11/08/2021
	Plan of Correction
1 2 3 4	Director states she will contact trainer and provide proof of completion to LPA by POC date via email.

Type B

Section Cited

CCR

101216(g)(1)

Personnel Requirements

(1) Except as specified in (3) below, good physical health shall be verified by a health screening, including a test for tuberculosis, performed by or under the supervision 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
1 2 3 4	Based on LPA record review, 2 of 4 staff members did not have proof of test of TB readily available at time of inspection. This poses a potential health, safety, and personal rights risk to children in care at time of inspection.
	POC Due Date: 11/08/2021
	Plan of Correction
1 2 3 4	Director states she will provide proof of missing staff TB tests to LPA by POC date via email.

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina Chicote	TELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:	DATE: 10/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021

LIC809 (FAS) - (06/04)

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