<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402109
Report Date: 04/18/2022
Date Signed: 04/18/2022 03:43:51 PM


Document Has Been Signed on 04/18/2022 03:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754



FACILITY NAME:EL SERENO ELEMENTARY SCHOOL, RM K-2FACILITY NUMBER:
197402109
ADMINISTRATOR:MORELAN, CHERYL A.FACILITY TYPE:
850
ADDRESS:3838 ROSEMEAD AVENUETELEPHONE:
(323) 222-3389
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:23CENSUS: 9DATE:
04/18/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:34 AM
MET WITH:Principal, Narajphan AsavasoponTIME COMPLETED:
03:50 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 Analyst’s (LPAs) Mireya Garcia and David Kurdoglyan conducted an unannounced Annual Required Inspection. LPAs met with Principal, Narajphan Asavasopon, who guided LPAs on a tour of the facility indoors and outdoors. This is an LAUSD state preschool program located in RM 2 on the premises of El Sereno Elementary School. The program consists of one (1) classroom; Room 2. This program operates a regular session from Monday through Friday 08:00am to 02:30pm. Per Principal, this facility is no longer operating AM/PM sessions.

Upon LPAs arrival there were nine (9) preschoolers present in the classroom with Staff #1, #2 #3 and #4. Teacher-child ratio is met. All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Los Angeles Unified School District. All children were observed to be under visual supervision of a teacher at all times.

REPORT CONTINUES ON NEXT PAGE 1 OF 5.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7


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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109
VISIT DATE: 04/18/2022
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
26
27
28
29
30
31
32
LPA’s observed the facility to be clean, safe, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Indoor classroom was inspected to ensure that the floor has a surface that is safe and clean. During LPAs walkthrough of the classroom it was observed that the electrical outlets were uncovered and later were covered. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free. At this time, the Nurse’s office is used as an isolation area which consists of a restroom, chairs and a clinical bed in the office. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted.

Food menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. Preschoolers are provided with Breakfast and Lunch by the Los Angeles Unified School District. All kitchen, food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPAs inspected that any contaminated food is discarded immediately. There is drinking water available in the indoor classroom (water bottles) and water bottles were observed in the classroom. All storage containers for solid waste, including moveable bins, have tight fitting covers on and are in good repair. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children. Teacher, Ms. De Lelio states that there are no poisons stored at the facility.

REPORT CONTINUES ON NEXT PAGE 2 OF 5.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 2 of 7
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109
VISIT DATE: 04/18/2022
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
26
27
28
29
30
31
32
During the walkthrough LPAs observed that the facility does not have any functioning carbon monoxide detector present. Per Principal, Narajphan Asavasopon she will get one installed while LPAs are present for this inspection. During this inspection, the carbon monoxide detector was placed inside Room 2, which was tested at 1:25 pm, and it is in operable condition. The facility representative takes measures to keep the facility free of flies, other insects and rodents.

Outdoor play equipment was observed to be in good condition, free of sharp, loose or pointed parts. Outdoor activity space surface is maintained in a safe condition as is free of hazards. The Principal states that there are no bodies of water on the premises and LPA did not observe any bodies of water during this visit.

Sign in and out sheets were reviewed by LPAs to ensure that children who are present where sign in. Staff Records were not available for review. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPAs issued the Children’s Record Review (LIC 857) and the Review of Staff records (LIC 859) to the Principal during this inspection. There is at least one person trained in Pediatric CPR/First Aid present during this inspection. Health preventative practices documentation were not available for review.



SB792 (Immunization Requirements for Staff and Employees) was discussed with the facility representative.

REPORT CONTINUES ON NEXT PAGE 3 OF 5.

SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 3 of 7
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109
VISIT DATE: 04/18/2022
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
26
27
28
29
30
31
32
AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers

Incidental Medical Services (IMS) policy was discussed. Per Principal facility currently has no children enrolled who require any medication. 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


The following was discussed:
· Reporting Requirements.
· The facility shall ensure that each child is accorded the following personal rights: to be accorded safe, healthful and comfortable accommodations.
· All personnel shall be in good health and shall be physically and mentally capable of performing assigned tasks; personnel that pose a threat to the health and safety of children shall be relieved of their duties.
· All personnel shall be given on the job training in housekeeping, sanitation principles and universal health precautions.

REPORT CONTINUES ON NEXT PAGE 4 OF 5.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 4 of 7
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 CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109
VISIT DATE: 04/18/2022
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
26
27
28
29
30
31
32
LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The deficiencies listed on the following pages were observed by the LPAs and are being cited in accordance with California Code of Regulations Title 22. Please see attached LIC 809D for deficiencies that are being cited and needs to be cleared to protect the children’s health & safety.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative, Narajphan Asavasopon.

REPORT ENDS HERE PAGE 5 OF 5.
SUPERVISOR'S NAME: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 5 of 7
Document Has Been Signed on 04/18/2022 03:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022

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 interview disclosure from Prinicpal all staff immunization records are not available for review which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
1
2
3
4
Per Principal, during todays inspection she began to create a staff records binder for future review and will obtain getting immunization records for all daycare staff and will submit proof of correction on or before 05/06/2022 to LPA Garcia via e-mail.
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 interview disclosure from Prinicpal all staff Mandated Reporter Training certificates of completion are not available for review which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
1
2
3
4
Per Principal, during todays inspection she began to create a staff records binder for future review and will obtain getting certificates of completetion of the Mandater Reporter Training for general and AB1207 courses for all daycare staff and will submit proof of correction on or before 05/06/2022 to LPA Garcia via e-mail.

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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 6 of 7


Document Has Been Signed on 04/18/2022 03:43 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 CNTR DR. 200-B
MONTEREY PARK, CA 91754


FACILITY NAME: EL SERENO ELEMENTARY SCHOOL, RM K-2
FACILITY NUMBER: 197402109

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101215.1(m)
Child Care Center Director Qualifications and Duties
(m) A child care center director shall complete 16 hours of health and safety training if necessary pursuant to Health and Safety Code Section 1596.866.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview disclosure from Prinicpal she does not have proof of completetion of 16 hours of health and safety training which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
1
2
3
4
Per Principal, she will complete 16 hours of health and safety training and will submit proof of correction on or before 05/06/2022 to LPA Garcia via e-mail.
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 interview disclosure from Prinicpal all staff records are not available for review which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/06/2022
Plan of Correction
1
2
3
4
Per Principal, during todays inspection she began to create a staff records binder for future review and will obtain getting documents for all daycare staff and will submit proof of correction on or before 05/06/2022 to LPA Garcia via e-mail.

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: Christina GabelmanTELEPHONE: (323) 981-3380
LICENSING EVALUATOR NAME: David KurdoglyanTELEPHONE: 323-981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
LIC809 (FAS) - (06/04)
Page: 7 of 7