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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402685
Report Date: 10/06/2022
Date Signed: 10/06/2022 04:59:12 PM


Document Has Been Signed on 10/06/2022 04:59 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:CATHOLIC CHARITIES, ST. ANASTASIA-ADESTEFACILITY NUMBER:
197402685
ADMINISTRATOR:OFELIA HERNANDEZFACILITY TYPE:
840
ADDRESS:8631 STANMOOR DRIVETELEPHONE:
(310) 645-8816
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:63CENSUS: 27DATE:
10/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:59 PM
MET WITH:Ofelia JimenezTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Doris Whitmore met with Ofelia Jimenez - Site Supervisor, for the purpose of an unannounced inspection. LPA toured the facility indoors and outdoors as identified per facility sketches.

Upon LPA arrival, 12 children were inside in the Parish Hall Teacher and 8 children inside of the Parish Hall. During the inspection more children came with a total of 27 children in all. LPA observed sign/sign out sheets. Facility is operating within capacity limitations classrooms. LPA inspected the classroom and found them to be clean and free from any potential hazards. LPA observed classrooms to have age-appropriate material and equipment. The facility operates Monday through Friday, from 2:15p.m. to 6:00 PM from Monday through Friday. There are no bodies of water on the premises during the visit. There is a separate Kitchen for after age program use.

Furniture in each classroom was found to be in good repair and age appropriate. There is adequate heating, lighting and ventilation. Drinking water is readily available in each classroom. Isolation area for sick students is located in the teachers’ lounge where there will be one staff that will be with the child.

Toilets, faucets and sinks are in operable condition. LPA Whitmore observed 2 restrooms has adequate toilet paper, hand soap and paper towels available. Bathrooms were found to be clean. There is adequate lighting/ventilation in the bathrooms. Meals are provided by the facility which is a snack. LPA observed the following documentation Posted on the board Menu, Notification of Parents Rights, Emergency Disaster Plan, Personal Rights, Daily Activity Schedule, & Earthquake Preparedness

Cleaning supplies are out of reach to the children and is stored separately in a locked room outside of classrooms.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CATHOLIC CHARITIES, ST. ANASTASIA-ADESTE
FACILITY NUMBER: 197402685
VISIT DATE: 10/06/2022
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Inspection of the outdoor play area was conducted climbing structures; slides are securely anchored with adequate resilient cushioning material underneath and around the perimeter.

Each child has their own water bottles that are labeled with their name. Water is available for the children indoors and outdoors if a child doesn’t not bring their water bottle. There is adequate shade for the children in care. There is appropriate fencing around the perimeter of the outdoor play area.

LPA observed First Aid kit fully stock with a working carbon monoxide, smoke detector, and Fire Extinguisher 3-A:40- B:C.

There was a total of 10 children files that were reviewed during the inspection and three staff files that included the Director, Site Supervisor, & Teacher Assistant. LPA observed current Pediatric First Aid CPR AED issue date 11/24/21 renew date 11/2023. Mandated Reporter Certificates expires 11/2025. LPA Whitmore reviewed the Preventative Health and Safety Certificate.

The following was discussed: Mandatory Forms for the children’s files and staff’s files, Requirements for disaster drills and documentation for both. Role and responsibilities of being a mandated reporter were discussed. The licensee was advised how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. The licensee was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco on the premises. LPA discussed 1207: Beginning January 1, 2018, this law requires all licensed providers, applicants, directors and employees to complete training no later than 3/30/2018 as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com

New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into childcare or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CATHOLIC CHARITIES, ST. ANASTASIA-ADESTE
FACILITY NUMBER: 197402685
VISIT DATE: 10/06/2022
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Incidental Medical Services: Policy was discussed. Facilities that provide Incidental Medical Services (IMS) must identify those services in their facility’s Plan of Operation and submit an updated Plan of Operation to the Department. Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Emptying an Ileostomy Bag. This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. 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 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 ADA requires that childcare providers not discriminate against persons with disabilities on the basis of disability, that is, that they provide children and parents with disabilities with an equal opportunity to participate in the childcare center's programs and services

Requirements for fingerprint clearances and associations were discussed with the licensee. Licensee can be cited a civil penalty of $100 per day, up to $500.00 (5 days) for the 1st offense and up to $3000.00 for the 2nd offense within a 12-month period. The licensee was advised of the requirement to report unusual incidents and/or injuries to the parent/guardian and licensing within the time frame specified by the regulation. The "Notification of Parent's Rights" (PUB394) poster must be posted in an area accessible to parents. The information regarding new legislation with regards to exemptions and Parent’s Rights was also Upon receipt of a citation for a Type A Deficiency, the director shall post the licensing report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report (LIC 809D/9099D) to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file.

SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: CATHOLIC CHARITIES, ST. ANASTASIA-ADESTE
FACILITY NUMBER: 197402685
VISIT DATE: 10/06/2022
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he licensee was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on childcare licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541
Email Address: childcareadvocatesprogram@dss.ca.gov

There were no deficiencies on 10/6/2022 Exit interview conducted and report was reviewed with Rocio Bach Director.
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC809 (FAS) - (06/04)
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