197408763-12-14-2020-30-CC-DMIA-BWARK4-20201214120455

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197408763
Report Date: 12/14/2020
Date Signed: 12/14/2020 01:59:16 PM

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:	WEST HOLLYWOOD CHILDREN'S ACADEMY		FACILITY NUMBER:	197408763
ADMINISTRATOR:	JOULIANA BARANOVA		FACILITY TYPE:	850
ADDRESS:	1030 N. VISTA STREET		TELEPHONE:	3235123946
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	35	CENSUS: 11	DATE:	12/14/2020
TYPE OF VISIT:	Case Management - Incident	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Joulianna Baranova, Director		TIME COMPLETED:	10:01 AM

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	On 12/14/2020 at 9:00 am, Licensing Program Analyst (LPA) Denise Miranda conducted an announced Case Management- incident inspection via Facetime. The purpose of the inspection was to observe and follow up on a recent Unusual Incident Report (Outbreak - COVID -19) that was reported to the Regional Office on 11/12/2020 and 11/24/2020 where 3 individuals tested positive for the COVID-19 Virus. The facility was closed from 11/16 and reopen on 11/30/2020. LPA observed three staff, director and 11 children in care. On 12/2/2020 Ms, Vanessa Valenzuela, RN, BSN, PHN, Community Liaison Public Health Nurse Los Angeles County Public Health Department and LPA Miranda jointed her visit via Facetime. During that visit, Ms. Valenzuela recommended the following recommendation: 1) Place social distancing markers on carpet, floor, and tables, both indoors and outdoor areas 2) Increase signage at gate entrance, restrooms and classrooms with COVID-19 education. 3) Place hand sanitizer in strategic indoor and outdoor areas 4) Each child should have their own school supplies 5) Place hand washing signage above sinks. 6) No sharing of toys or school supplies 7) Toys should be cleaned after being used. 8) Place social distancing markers in eating areas. 9) Must remove 2 waters dispensers noted indoors and outdoors. Students to bring their own labeled water bottles 10)Isolation area should be away from students and staff with a restroom nearby. 11)Quarantine area can be outdoors, weather permitting. 12)Isolation and quarantine areas need PPE stored just outside the area. 13)Have gloves, masks and gowns accessible to staff to provide individual assistance to students.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

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 2

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: WEST HOLLYWOOD CHILDREN'S ACADEMY	FACILITY NUMBER: 197408763
	VISIT DATE: 12/14/2020

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

14) Students 3 years and older need to wear a mask.
15) Staff help students follow social distancing markers.
16) Put markers on outdoor areas where students are present.
17) Have hand sanitizers accessible in restrooms in case soap is not available.
18) Check all cleaning products to be EPA
19) Suspend onsite tours and visitors
20) No new enrollment during outbreak.

Director provided -a copy of a COVID-19 Outbreak Clearance Letter signed today, by Sonali Kulkarni, M.D. M.P.H. Medical Director from County of Los Angeles Department of Public Health stated that as 12/14/2020 the Public Health has determined that the outbreak at the facility has ended. The Health officer Order for the control COVID-19 is rescinded and all related requirements and restrictions are removed.

On 12/14/2020 LPA toured the facility indoor and outdoor guided by Ms. Joulianna Baranova and observed that the Facility is in compliance according to Title 22 and all recommendations above provided by Ms. Valenzuela on 12/2/2020.
An exit phone interview has been conducted with Ms. Joulianna Baranova, Director. A copy of this report has been signed by LPA Miranda. This report along with the Notice of Site Visit will be scanned via e-mail to Director Ms. Baranova, who understands that an electronic “Read Receipt” and/or confirmation of receipt of the e-mail confirms receipt of the report and constitutes an electronic signature.
A hard copy of this report and the Notice of Site Visit will be placed in the mail and Licensee agrees to sign the bottom of each page of the 809 and return the originals to LPA Miranda in-person or via U.S. Mail.

SUPERVISOR'S NAME: Peter Flores	TELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise Miranda	TELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

LIC809 (FAS) - (06/04)

Page: 2 of 2