197409567-11-5-2021-30-CC-LRIS-C8GPA9-20211105110823

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197409567
Report Date: 11/03/2021
Date Signed: 11/05/2021 11:08:44 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:	CHILDREN OF OUR SAVIOR PRE-SCHOOL		FACILITY NUMBER:	197409567
ADMINISTRATOR:	CHARSHA, BEVERLY		FACILITY TYPE:	850
ADDRESS:	6705 W. 77TH STREET		TELEPHONE:	(310) 215-3166
CITY:	WESTCHESTER	STATE: CA	ZIP CODE:	90045
CAPACITY:	144	CENSUS: 65	DATE:	11/03/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Director Katia Pacheco		TIME COMPLETED:	04:00 PM

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 11/3/21 Licensing Program Analysts (LPA) Lisa Rios and Meaghan McGee, conducted an unannounced Annual Required Inspection for the preschool license. LPAs met with Director Katia Pacheco and toured the facility indoors and outdoors. Days and hours of operation are Monday-Friday from 8:00am-5:00pm. Due to Covid-19 Masks are worn by all staff and students and hand sanitizers are located throughout the facility offered both indoors and outdoors. The facility was inspected inside and out. Inside: the facility consists of 6 classrooms. All classrooms have disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible (see TV). Inside: Furniture and equipment are in good condition, free of sharp, loose or pointed parts. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. Each Classroom has required postings, a smoke/carbon monoxide detector and a fire extinguisher is in each room and at least as big as an 2A10BC. Each classroom has a fully equipped first aid kit, an emergency disaster kit for each child and disaster drills are not posted and not accessible. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All foods/beverages capable of rapid spoiling are stored in covered containers at 45 degrees F or less. Some solid waste storage containers have tight-fitting covers and are in good repair.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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: CHILDREN OF OUR SAVIOR PRE-SCHOOL	FACILITY NUMBER: 197409567
	VISIT DATE: 11/03/2021

NARRATIVE

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Outside:
Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. All materials and surfaces accessible to children are toxic free. The facility is free of flies, insects and rodents.

LPAs reviewed 10% or 10 (whichever number is higher) children’s files and observed some files were incomplete with Health History Reports, Consent for medical treatment and notification of licensing reports. LPAs reviewed all staff files and observed some files were incomplete with documentation of meeting qualification requirements, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training.

LPAs and Director 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.

Licensee [or facility representative] 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

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

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: CHILDREN OF OUR SAVIOR PRE-SCHOOL	FACILITY NUMBER: 197409567
	VISIT DATE: 11/03/2021

NARRATIVE

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Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, the following deficiencies are being cited: (see next page, 809 D). The Director was provided a copy of their appeal rights.

Upon receipt of a Type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 was given to licensee.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISOR'S NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

Page: 2 of 7

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: CHILDREN OF OUR SAVIOR PRE-SCHOOL	FACILITY NUMBER: 197409567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101174(b)(2)(C)

Disaster and Mass Casualty Plan

(b) The plan shall be subject to review by the Department and shall include: (2) Contingency plans for action during fires, floods and earthquakes including, but not limited to, the following: (C) Transportation arrangements. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in having a transportation plan written into the mass casualty plan.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	Director shall edit the mass casualty plan to include transportation and email to LPA Rios at lisa.rios@dss.ca.gov no later than December 3rd, 202.

Type B

Section Cited

CCR

101174(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	LPA Rios a copy of the disaster drill log after disaster drills have been completed by December 3rd, 2021.

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

Page: 4 of 7

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: CHILDREN OF OUR SAVIOR PRE-SCHOOL	FACILITY NUMBER: 197409567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101238(b)(1)

Buildings and Grounds

(1) Protective devices including but not limited to nonslip material on rugs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, 3 rugs in several classrooms need non slip material placed underneath.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	The Director ahll provide photos of the rugs non slip material to lisa.rios@dss.ca.gov by December 3rd, 2021.

Type B

Section Cited

CCR

101239(f)(1)

Fixtures, Furniture, Equipment and Supplies

(f) Solid waste shall be stored, located and disposed of in a manner that will not transmit communicable diseases or odors, create a nuisance, or provide a breeding place or food source for insects or rodents. (1) All containers used for storage of solid wastes, including moveable bins, shall have a tightfitting cover that is kept on; shall be in good repair; and shall be leakproof and rodent-proof. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 4 out of 11 trashcans which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	Director will buy new trashcans with lids and email a picture to lisa.rios@dss.ca.gov by December 3rd, 2021.

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021

LIC809 (FAS) - (06/04)

Page: 5 of 7

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: CHILDREN OF OUR SAVIOR PRE-SCHOOL	FACILITY NUMBER: 197409567
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2021

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
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one teacher needs an MMR vaccine, one teacher needs the Dtap vaccine and all teachers need to update their flu waivers each year which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	The Director shall e waivers to lisa.rios@dss.ca.gov by December 3rd, 2021.

Type B

Section Cited

CCR

101216(l)(1)(B)

Personnel Requirements

(B) A copy of the signed LIC 9052 (11/94) shall be kept in the employee's personnel record. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 3 of the 10 which poses/posed a potential health, safety or personal rights risk to persons in care..
	POC Due Date: 12/03/2021
	Plan of Correction
1 2 3 4	Director will email LIC9052's to lisa.rios@dss.ca.gov by December 3rd, 2021.

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: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR NAME: Lisa Rios	TELEPHONE: (424) 301-3072
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC809 (FAS) - (06/04)

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