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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197405898
Report Date: 02/13/2020
Date Signed: 02/13/2020 10:52:53 AM

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:LAWNDALE SCHOOL DISTRICT-JANE ADDAMS PRESCHOOLFACILITY NUMBER:
197405898
ADMINISTRATOR:NOYES, FRANKFACILITY TYPE:
850
ADDRESS:4535 W. 153RD PLACETELEPHONE:
(310) 679-7981
CITY:LAWNDALESTATE: CAZIP CODE:
90260
CAPACITY:19CENSUS: 0DATE:
02/13/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Claudia MaldonadoTIME COMPLETED:
10:52 AM
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On 2/13/2020, Licensing Program Analyst (LPA) Helen Estrella conducted an unannounced 1-year inspection to ensure the health and safety standards as required by regulations governing family child care homes are being met. Upon arrival, LPA met with the licensee Claudia Maldonado. There was no children present at the time of the inspection.

The licensee requested at this time to go on inactive status. LPA explained Inactive status with the licensee and informed that she must comply with the following: licensee will not provide child care for which a license is required until the license is reactivated; licensee will promptly pay the annual fees; licensee will inform the Department of any changes in the inactive dates prior to re-opening the facility by submitting a new (LIC 9211); licensee will be in compliance with all licensing laws and regulations upon re-opening the facility, including but not limited to: 1. ensuring all staff and residents including children who turn 18 have criminal record/TB clearances. 2. licensee to maintain current CPR/First Aid certification and 3. licensee to maintain serviced 2A10BC Fire Extinguisher.

LPA observed facility. There is 2A10BC fire extinguisher. Licensee has active Pediatric/CPR certification 9/4/2020. LPA observed carbon monoxide detector. LPA observe room with recreation equipment. The licensee stated the preschool room has not been used since June 2017 due to low enrollment. However the licensee appears to maintain compliance with maintenance of the license and facility.

LPA provided the licensee with a Request for Inactive Status form (LIC 9211). Licensee completed form and requested inactive status 2/13/2020 to 2/13/2021.

A copy of this report and notice of site visit was provided to the licensee. Exit interview conducted.
SUPERVISOR'S NAME: Jennie FerreiraTELEPHONE: (424) 301-3073
LICENSING EVALUATOR NAME: Helen EstrellaTELEPHONE: (424) 301-3073
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2020
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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