191870652-2-2-2023-54-CC-DGIS-CNNRKG-20230202120531

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870652
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:05:44 PM

Document Has Been Signed on 02/02/2023 12:05 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:	DOLORES STREET EARLY EDUCATION CENTER		FACILITY NUMBER:	191870652
ADMINISTRATOR:	MIRA HAGOOD		FACILITY TYPE:	850
ADDRESS:	22309 CATSKILL AVE		TELEPHONE:	(310) 830-6987
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	116	CENSUS: 87	DATE:	02/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Mira Hagood, Facility Representative		TIME COMPLETED:	12:15 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	Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 2/2/23 at 8:45 AM. LPA met with Mira Hagood, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program that operated Monday-Friday, 7:15AM-5:30PM. There were 87 children and 17 staff present when LPA arrived. Facility is in compliance with License capacity and Title Five ratio guidelines. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. LPA observed required posted documentation which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights and Lunch/Snack Menu. All documents observed. Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 1/26/2023. All documents observed. At 9:15 AM LPA toured Classrooms #1/PCC, #2 ,and #3A/B, All classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. Rugs were observed to lay flat on the ground to avoid tripping hazards. LPA discussed rug cleanliness with FR. Water is made readily available by via operable water fountains in each classroom. Children also bring water bottles from home that can be refilled freely. Per FR, there are currently children with medication. Medication is stored in the main office in the nurses cabinet. Children have cubbies to store personal belongings separate from each other. LPA observed cots for napping. Bedding is provided by facility and washed weekly by a laundry service. There are no firearms or weapons on the premises. ---------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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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: DOLORES STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 191870652
	VISIT DATE: 02/02/2023

NARRATIVE

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At 9:40AM LPA toured the outdoor play area. Children have multiple areas for activities. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structures to absorb fall. Shade was observed throughout the outdoor area and water was observed to be readily available via water fountains and water bottles. LPA did not observe hazards in the outdoor space.

At 9:50 AM LPA toured the children’s restrooms. Restroom for Rooms #1 and #2 are located right outside of their classroom off the hallway. Room#3 has their own restroom located inside the classroom. Restrooms were observed to be safe and sanitary with operable sinks and toilets.

At 9:55 AM LPA toured the kitchen located adjacent to the main office. Facility provides AM snack, PM snack and lunch. Food is not cooked at facility. Prepackaged food is brought from the neighboring, elementary school. Extra food is discarded after meals. Kitchen was observed to be clean, free of litter, insects and rodents. LPA observed trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Carbon Monoxide detector wired with smoke and fire alarm. Required lead testing has been completed and documents submitted, results do not show and exceedance of lead.

At 10:00 AM LPA reviewed Sign In/Out sheets located at the front entrance. All children present were signed in with date, time and full signature of the child's representative.

Children’s records were reviewed at 10:15 AM for Emergency Card, Immunization Records, Licensing Form (LIC) 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. LPA reviewed documentation and expiration dates for medication. All dates are current with signed documentation. All files reviewed were complete.

Staff records were reviewed at 11:00 PM for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization 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. Documents were discussed.
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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: DOLORES STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 191870652
	VISIT DATE: 02/02/2023

NARRATIVE

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During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from corporal and/or unusual punishment.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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

Based on LPA's observation. No deficiencies will be cited today 2/2/23. Technical Assistance provided.

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 Mira Hagood.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

LIC809 (FAS) - (06/04)

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