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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 192001360
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:50:30 PM

Document Has Been Signed on 05/04/2023 03:50 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:JEFFERSON STATE PRESCHOOLFACILITY NUMBER:
192001360
ADMINISTRATOR:MARCOS, MARIOFACILITY TYPE:
850
ADDRESS:2508 E. 133RD STREETTELEPHONE:
(310) 898-6008
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 12DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Dalia Mosqueda/Maria E. SanchezTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Warren Birks conducted an unannounced Required - 1 Year Inspection. LPA met with Lead Teacher(LT) Dalia Mosqueda who assisted analyst with a tour of the facility. Upon arrival LPA observed Lead Teacher (LT) Dalia Mosqueda and two assistants caring for 12 children outdoors. This is a Preschool Program serving children ages two (2) years to kindergarten. The hours of operation are: Monday through Friday 7:45am to 11:00 am and 11:45 to 2:45pm. The preschool operates on the grounds of a Kindergarten through eighth grade (K-8) school. The preschool program (indoors) is physically separate. The outdoor has no physical separation and staff are required to provide adequate supervision. The children do not commingle with the K-8. Parents are checked in the school through a secured entrance. LPA closed out report with Assistant Principal Maria E. Sanchez.

All areas identified on the Facility Sketch were inspected. LPA observed: Room 1 (3 staff and 12 children), LPA inspected all classrooms and all outdoor areas. LPA observed furniture and equipment appear to be age appropriate and in good repair. LPA observed telephone service, heating, lighting and ventilation to be satisfactory. Children have adequate cubby storage for their belongings. The children do not nap as this is a half day program. LPA observed drinking water and cups readily available in the classrooms and outdoors. LPA inspected restrooms to determine: age appropriateness (sinks and toilets), water temperature, availability, functionality, adequate supply of paper products, safety and sanitation. All toilets and sinks are in operable condition.


All indoor classrooms have surfaces that appear to be clean and safe. All materials and surfaces accessible to children are toxic free. Storage areas for poisons are locked in containers inaccessible to children. LPA observed no weapons or bodies of water at the facility. LPA observed outdoor play equipment to be in good condition, free of sharp, loose or pointed parts. The outdoor activity space surface is maintained in a safe condition and appears to be free of uncommon hazards. At approximately 1:45pm LPA observed paper and plastic debris in a side area near the playground. LPA informed LT Mosqueda to ensure that the area is cleaned as wind and rain cause the area to attract debris.
SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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: JEFFERSON STATE PRESCHOOL
FACILITY NUMBER: 192001360
VISIT DATE: 05/04/2023
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There was a cone to attempt to prevent children from accessing the area. LPA issued a technical advisory violation regarding the debris as the area was still accessible and not sanitary. Areas around and/or under climbing equipment have cushioning material to absorb a fall. All materials and surfaces accessible to children appear to be toxic free. At this time, the office is used as an isolation area to care for ill children. Children can rest on a cot or sit in a chair. Parents are contacted immediately if children are ill.

LPA reviewed snack menus that are posted at least one week in advance and visible to authorized representatives. The facility provides breakfast lunch and AM and PM snacks provided by the K-8th school next door. LPA also observed drinking water available indoors and outdoors and trash receptacles that have tight fitting covers.

Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are locked and/or inaccessible. The facility has one or more functioning smoke detectors and carbon monoxide detectors that meet statutory requirements (electronically wired to the facility).

LPA observed sign in and sign out forms to ensure children are being properly signed in and signed out. LPA will have to make an additional visit to observe children's records to review items such as Identification and Emergency forms, Immunization records, Health History, Personal Rights, Parents Rights etc. on file.

Staff Records will be reviewed at a later date: to ensure the following: Appropriate documentation of education credits, Criminal Record Clearance documents available, Verification of current CPR/First Aid and health preventative practices, proof of immunization against pertussis and measles and influenza and/or flu declination available.

*Note: LPA will review staff files at a later date at the Human Resources office on 501 S. Sante Fe Ave. Compton, CA 90221.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes 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 Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
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: JEFFERSON STATE PRESCHOOL
FACILITY NUMBER: 192001360
VISIT DATE: 05/04/2023
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Note: First Aid supplies were observed in each classroom. Medication is only administered to children once parent's provide a doctor's note. All medications are stored in a locked cupboard for inaccessibility. LPA reminded Assistant Principal Sanchez that any construction should be reported to the Department before it occurs.

Mandatory forms for the children’s files and staff files, requirements for fire drills, earthquake drills and documentation were discussed. Role and responsibilities of being a Mandated Reporter were reviewed. 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. LPA advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.



LPA informed staff that all adults 18 years of age and older providing Care & Supervision and having a continuous presence in the facility shall adhere to a criminal background clearance with the Department of Justice, FBI and Child Abuse Index Check. LPA informed Director to log onto web site www.ccld.ca.gov to access forms, regulations and quarterly updates. Records for all children and staff must be maintained for three (3) years after separation from the facility. Report Unusual Incidents and/or injuries to the parent/guardian immediately and to Child Care Licensing within 24 hours and/or the next business day. Visit www.shotsforschool.org for immunization information. All care for children require supervision at all times. If away from the facility, staff must be with children at all times (especially when outdoors).

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/tion-process.

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 with Assistant Principal Maria E. Sanchez and a copy of Appeal Rights (LIC 9058) was discussed and provided

SUPERVISORS NAME: Karen Chambers
LICENSING EVALUATOR NAME: Warren Birks
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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