191802294-11-8-2022-54-CC-AMOY-CKYUKE-20221108143901

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191802294
Report Date: 11/08/2022
Date Signed: 11/08/2022 02:39:16 PM

Document Has Been Signed on 11/08/2022 02:39 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, 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: 15	DATE:	11/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Leslie Nicho, Director		TIME COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Alicia Mooberry conducted an unannounced Annual Required Inspection on 11/8/22. This is a preschool age program licensed for 60 children which operates Monday – Friday from 7:30 AM – 6:00 PM. Per the Director there are 23 children enrolled. The facility is located on the property of the Higashi Hongwanji Buddhist Church. LPA arrived at the facility at 10:40pm and met with Leslie Nicho, Director, who provided tour of the facility. The following census was observed: 2 children and 1 staff in Room 6 (Kindergarten room), 5 children and 1 staff in Yellow Room (4 years old classroom), 4 children and 1 staff in Red Room (Pre-K classroom) and 4 children with 1 staff in Orange Room (2-3 years old classroom). Isolation area for sick children is in Room 7, which serves as a utility room and Office. All adults present have received their background clearance.

LPA observed required posted documentation located in the hallway by the playground, which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System and LIC 613A- Notification of Parent’s Rights. LPA advised Director to post documents in area that is visible to parents of children enrolled.

Sign In/Out sheets were reviewed and evaluated, LPA observed that 4 out of 15 children present were not signed in or were signed in on incorrect date which poses a potential health, safety or personal rights risk to persons in care.

LPA observed that furniture and equipment in classrooms is maintained in good condition, free of loose, sharp and/or pointed parts. The floors of the classroom has surfaces that are safe and clean. Drinking water is made readily available for the children via a filtered water dispenser, children bring their personal water bottles from home. LPA observed required Carbon Monoxide and smoke detector that is operable.

Cleaning products are stored in the kitchen, inaccessible to children.

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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: 11/08/2022

NARRATIVE

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Children enrolled bring their lunch from home in insulated bags. The facility provides morning and afternoon snacks. All kitchen areas and food storage areas was observed to be clean and are free of litter, rubbish, rodents, and/or any other vermin. Per Director there are no poisons stored in the facility. Pest control service conducts service monthly.

All storage containers for solid waste have tight-fitting covers that are kept on, and in good repair

LPA observed medication is stored in storage room on top of a file cabinet inaccessible to children in care.

Restroom was observed to be in good repair, sanitary and free of hazards. Restroom is located in the hallway by preschool classrooms.

LPA observed he outdoor space is free of hazards. There is cushioned material under climbing structure to absorb fall. Outdoor space has various areas of shade for children to play. There is a functioning water fountain that is accessible to children, per director the fountain is not used at the moment, the children bring personal water bottles from home that are refilled from water dispenser in multi purpose room. There are no pools, spas, or other bodies of water on school grounds.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 10/20/2022.

Children’s records were reviewed for Emergency Card, Immunization Records, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All children's records were complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC-501: Personnel Record, LIC 503- Health Screening, LIC 508- Criminal Record Statement, LIC 9052- Employee Rights, Proof of immunization's against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit and current Mandated Reporter Training Certificate. LPA observed that Staff #4 is missing the Mandated Reporter Training Certificate (AB1207) and LIC 9050 Employee Rights.

LPA discussed Lead Testing Directive (PIN 21-21-CCP) with Director.

LPA observed that facility is implementing COVID-19 precautions and procedures. For the latest guidance on COVID-19 visit your local public health department website..

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SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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: 11/08/2022

NARRATIVE

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Children were observed napping in the multipurpose room, linens are washed weekly by parents.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Director 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.

Based on the LPA’s observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) is 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

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

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, Leslie Nicho.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/08/2022 02:39 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
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: 11/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101229.1(d)

Sign In and Sign Out

(d) The sign-in and sign-out sheets with the signatures required by this section and by Section 101226.1 shall be kept for one month and shall be available at the center for review by the Department. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and record review, the licensee did not comply with the section cited above in 4 out of 15 children present were not signed in or were signed in on incorrect date which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/10/2022
	Plan of Correction
1 2 3 4	Per Director, the sign in sheets will be completed and a copy sent to the department by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Alicia Mooberry	TELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC809 (FAS) - (06/04)

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