191870758-6-17-2022-54-CC-DGIS-CFGQ8U-20220617115720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191870758
Report Date: 06/17/2022
Date Signed: 06/17/2022 11:57:29 AM

Document Has Been Signed on 06/17/2022 11:57 AM - 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:	ONE HUNDRED SECOND STREET EARLY EDUCATION CENTER		FACILITY NUMBER:	191870758
ADMINISTRATOR:	YVETTE MONTEILH		FACILITY TYPE:	850
ADDRESS:	1925 EAST 102ND STREET		TELEPHONE:	(323) 569-8159
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90002
CAPACITY:	112	CENSUS: 15	DATE:	06/17/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Esther Campbell, Facility Representative		TIME COMPLETED:	12:10 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 6/17/22 at 8:45AM. LPA met with Esther Campbell, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program. Hours of operation Monday-Friday 8:30AM-4:30PM. There were 15 children and seven staff present when LPA arrived. Facility capacity is in compliance with license 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 at the facility entrance 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 6/6/2022. LPA toured the outdoor play area. 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 structure to absorb fall. Shade was observed throughout the outdoor area and water was observed to be readily available via water bottles children bring from indoors. LPA toured Classrooms Room #, #2 and #3. All classrooms had furniture in good condition, free of loose, ----------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

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: ONE HUNDRED SECOND STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 191870758
	VISIT DATE: 06/17/2022

NARRATIVE

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sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. Rugs were observed to lay flat on the ground to avoid tripping hazards. Water is made readily available by via water bottles provided by facility. Water fountains in classroom's are not in use due to COVID-19 precautions. Per facility representative, there are no children currently with medication and there is no medication stored at the facility. Children have cubbies to store personal belongings separate from each Children use cots for nap. Bedding is provided by facility and washed weekly.

LPA toured the children’s restrooms. Restrooms were observed to be safe and sanitary with operable sinks and toilets. Facility has three restrooms. LPA observed one restroom is closed for maintenance. Per Building and Grounds staff, restroom has been closed for repair since 6/13/22 and will be closed for another two weeks. LPA does not have an Unusual Incident Report on file regarding restroom. Incident reporting was discussed with FR.

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. No food is stored in the kitchen. 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. Per FR, carbon monoxide detector is combined with facility smoke/fire alarm.

LPA reviewed Sign In/Out sheets located outside the entrance. All children present were signed in with date, time and full signature of the representative who dropped off the child. Due to COVID-19 precautions parents do not enter the facility. A digital daily pass (approved child health assessment) is scanned and the child is dropped off with a staff member.

Children’s records were reviewed 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. Files were discussed.

Due to facility administrator being off campus at a meeting, staff files were not available for review. Administrator had the key to access the files. This is a violation is title 22.
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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: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

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: ONE HUNDRED SECOND STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 191870758
	VISIT DATE: 06/17/2022

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.

LPA observed that facility is implementing COVID-19 precautions and procedures as required by Los Angeles Unified School District and the Department of Public Health.

LPA discussed the children's roster LIC 9040 and the staff roster with FR.

Incidental Medical Services (IMS):
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

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

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 Esther Campbell.

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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: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 06/17/2022 11:57 AM - 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: ONE HUNDRED SECOND STREET EARLY EDUCATION CENTER	FACILITY NUMBER: 191870758
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/17/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101217(d)

Personnel Records

(d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 7 OUT OF 7 STAFF FILES which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/30/2022
	Plan of Correction
1 2 3 4	Per FR, all documents will be emailed to LPA by POC date 6/30/22

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: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022

LIC809 (FAS) - (06/04)

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