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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402109
Report Date: 02/23/2023
Date Signed: 02/23/2023 12:08:53 PM


Document Has Been Signed on 02/23/2023 12:08 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:ASAVASOPON, NARAJPHANFACILITY TYPE:
850
ADDRESS:3838 ROSEMEAD AVENUETELEPHONE:
(323) 222-3389
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:23CENSUS: 16DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Principal, Narajphan AsavasoponTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced Annual Required Inspection. LPA met with Principal, Narajphan Asavasopon, who guided LPA 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. Facility operation hours are Monday through Friday from 8:00 AM to 2:30 PM. This facility has a capacity of 23 children; preschool children ages 2.9 to 5 years old.

Upon arrival, the following staff were present during this inspection: RM 2: Staff #1, #2, #3 and #4 with 16 preschoolers (11 CSPP children and 5 children from the Preschool For All Learners program were present). 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.

LPA 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. All toilets and hand washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free.
REPORT CONTINUES ON NEXT PAGE 1 OF 4.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
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 6


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: 02/23/2023
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At this time, the Nurse's office is used as an isolation area. There are chairs and a sick bay 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 LPA inspected that any contaminated food is discarded immediately. The facility representative takes measures to keep the facility free of flies, other insects and rodents.

Per Principal, children bring their water bottles from home and there is a filtered water fountain in the classroom. Also, water bottles are provided if needed. 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. Principal states that there are no poisons stored at the facility.

Facility has one functioning carbon monoxide detector that meets statutory requirements. The carbon monoxide detector is located inside room #2 (outlet near the bulletin board wall), which was tested at 9:25 am, and it is in operable condition.

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.


REPORT CONTINUES ON NEXT PAGE 2 OF 4.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 2 of 6
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: 02/23/2023
NARRATIVE
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Sign in and out sheets were reviewed by LPA to ensure that children who are present where sign in. Staff Records were reviewed to ensure that personnel records are maintained on all staff. Staff #1-5 were missing documentation required. Children’s Records were reviewed to ensure that Identification and Emergency form and a medical assessment are on file. LPA 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 CPR and Pediatric 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. Staff #2, #3, #4, and #5 were missing immunization's on file.

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. This facility provides Incidental Medical Services – IMS. Per Principal at this time there is no children enrolled who require any medications. LPA provided technical assistance in the storage of medications and equipment/supplies, and the requirements for review of children’s, personnel, and administrative records. 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
REPORT CONTINUES ON NEXT PAGE 3 OF 4.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 3 of 6
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: 02/23/2023
NARRATIVE
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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.

LPA advised the facility representative to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The following deficiencies are being cited in accordance to Title 22 of the California Code of Regulations and Health & Safety codes. Please refer to LIC809D for documentation of deficiencies cited.

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

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

REPORT ENDS HERE PAGE 4 OF 4.
SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 02/23/2023 12:08 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: 02/23/2023

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
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Based on interview disclosure from Prinicpal and records review staff #2, #3, #4, and #5 immunization records are not available for review which poses potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2023
Plan of Correction
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Per Principal, she has create a staff records binder to place all required staff documents for CCLD future review and will work on obtain immunization records for all staff and will submit proof of correction on or before 03/09/2023 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
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Based on interview disclosure from Prinicpal and records review staff #3 and #4's 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: 03/09/2023
Plan of Correction
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Per Principal, she 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 03/09/2023 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6


Document Has Been Signed on 02/23/2023 12:08 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: 02/23/2023

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
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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 risk to persons in care.
POC Due Date: 03/09/2023
Plan of Correction
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Per Principal, she will complete 16 hours of health and safety training and will submit proof of correction on or before 03/09/2023 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
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Based on interview disclosure from Prinicpal staff records for staff #1, #2, #3 and #4 are not available for review which poses potential health, safety risk to persons in care.
POC Due Date: 03/09/2023
Plan of Correction
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Per Principal, she will obtain getting all required documents for all daycare staff and will be placed in staff binder for CCLD future review. In addition, Principal will submit proof of correction on or before 03/092023 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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3390
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2023
LIC809 (FAS) - (06/04)
Page: 6 of 6