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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197402904
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:13:53 PM


Document Has Been Signed on 02/17/2023 12:13 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:VOA/PUEBLO DE NINOS HEAD STARTFACILITY NUMBER:
197402904
ADMINISTRATOR:AGUAYO, I AND DUENAS, DFACILITY TYPE:
850
ADDRESS:11630 HESBY STREETTELEPHONE:
(818) 766-8103
CITY:NORTH HOLLYWOODSTATE: CAZIP CODE:
91601
CAPACITY:60CENSUS: 32DATE:
02/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Edie Smith- Area ManagerTIME COMPLETED:
12:15 PM
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On 2/17/2023 Licensing Program Analyst (LPA) Doris Whitmore and Jillinda Chandler conducted an announced Case Management Licensee Initiated. Applicant is requesting to add room 03 to their license. The center currently have four classrooms dedicated to preschool operations.LPA met with Area Manager Edie Smith - who provided a tour of the facility inside and outside. The facility's hours of supervision are Monday - Friday; class room Early Head Start 8:00-3:00p.m.; HeadStart 8:00-2:30p.m./8:15-2:45; Headstart Extended Day 8:15-2:30 The facility is a two story building located on the premises of First Presbyterian Church, day care operations are held on the lower level..
The physical plant was inspected for Title 22 compliance.

LPA observed the following room 03
LPA observed age appropriate furniture and equipment
The classroom was cleaned and well ventilated
The classroom measurements were 323.74 divided by 35 square feet for a total of 9 children
The facility has three play yards, room 3 will utilize the play yard directly outside of their classroom
SUPERVISOR'S NAME: Claudia EscobedoTELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Doris WhitmoreTELEPHONE: 424-301-3029
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VOA/PUEBLO DE NINOS HEAD START
FACILITY NUMBER: 197402904
VISIT DATE: 02/17/2023
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The facility had fire extinguishers of 2AB10 or larger, last inspected 4/21/2021, carbon and smoke detectors were also observed. Required postings were observed in a prominent area for parents and other authorized individual review.
Per facility staff, all food items and snacks are delivered daily to the facility from the licensee’s main kitchen. Menus were posted. Allergies and food preferential were identified in kitchens, classrooms and the main kitchen in the case of alternative meals needed for the identified children. The site uses a counter top with-in the classroom for food prepping area was observed to be clean with the essentials for food prepping storage, and refrigeration. All foods capable of contamination were labeled and stored properly, these foods were found to be in sufficient amounts and suitable for consumption. Cleaning supplies stored in this area were made inaccessible to children All trash cans used for soiled items or foods, had tight fitting lids. Outdoor equipment was in good repair. First aid kits were located in each class room with the required medical essentials: scissors; tweezers; ointment and bandages. Per the site director there are no guns or weapons on campus
In the outdoor activity area LPA observed; age appropriate toys and equipment, shade, benches or other resting equipment, drinking water was available by water container and disposable cups, adequate cushioning was provided under fall zones. No sharp edges, tripping, no bodies of water or other hazardous conditions were observed during today’s inspection.

Staff and Children files were reviews and found to be in compliance. All required staff were criminal background cleared. Site supervisor was advised that physician reports should be updated periodically.

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

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VOA/PUEBLO DE NINOS HEAD START
FACILITY NUMBER: 197402904
VISIT DATE: 02/17/2023
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The outdoor activity for this classroom measured 2006.26 divided by 75 square feet for a total of 26 children

Based on todays measurements and inspection the request to add rooms 03 to the license will be granted.

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

applicant was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with applicant and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

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

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245
FACILITY NAME: VOA/PUEBLO DE NINOS HEAD START
FACILITY NUMBER: 197402904
VISIT DATE: 02/17/2023
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LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Exit interview conducted and report was reviewed with the facility representative Edie Smith

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

DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023
LIC809 (FAS) - (06/04)
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