<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197411187
Report Date: 08/26/2019
Date Signed: 08/26/2019 02:40:51 PM

COMPREHENSIVE INSPECTION
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOLFACILITY NUMBER:
197411187
ADMINISTRATOR:GORSUCH, MICHELLEFACILITY TYPE:
850
ADDRESS:6017 FRANKLIN AVENUE, ROOM 23TELEPHONE:
(323) 464-1722
CITY:LOS ANGELESSTATE: CAZIP CODE:
90028
CAPACITY:23CENSUS: 3DATE:
08/26/2019
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Principal, Steve Salva TIME COMPLETED:
02:45 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
Licensing Program Analyst (LPA) Mireya Garcia conducted an unannounced required visit. LPA met with Eliza Markaryan, Head Teacher. Also present was Veronika Darbinyan, School Administrator Assistant. Principal was not available upon LPA arrival.

This is an LAUSD state preschool program located in RM 2 on the premises of Cheremoya Elementary School. There were 3 children present upon LPA arrival. This program runs an AM (8AM-11AM) and PM (12PM-3PM). This program operates under California Code of Regulations Title 5, which states that contractors shall maintain at least the following minimum for preschool: Preschool (36 months to enrollment in kindergarten) - 1:8 adult-child ratio, 1:24 TEACHER-CHILD ratio. The following was observed during the tour of the facility:

PHYSICAL PLANT
Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. The children hang their jackets/bag packs in a closet. LPA did observe that RM 2, was missing electric outlet covers during the inspection. Per Principal, the isolation area is located in the health office. In the health office a mat can be placed on the floor for an ill child and the staff restroom is readily available if an ill child requires it. Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. LPA observed that the facility does not have a carbon monoxide detector. Per the school’s plant manager there is no carbon monoxide detector on the premises. General sanitation was observed. Availability of indoor drinking water was observed inside classroom.

Disinfectants, cleaning solutions and other items that are dangerous to children, were inaccessible to children in all areas. Head Teacher Eliza Markaryan, states that there are no poisons stored at the facility.

-------CONTINUES PAGE 1 of 4

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 197411187
VISIT DATE: 08/26/2019
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
The facility was observed to be free of flies, other insects and rodents. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids.

Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. LPA Garcia advised Principal Steve Salva that the children need to be within the direct care and supervision, including visual supervision, of the teacher(s) and supervising staff at all times. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

FACILITY RECORDS

All individuals present have obtained a criminal record clearance or criminal record exemption. All staff have received an active criminal record clearance as a condition of their employment with the Los Angeles Unified School District. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPA issued the Children’s Record Review (LIC 857) to the Principal during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPA also issued the Review of Staff records (LIC 859) to the licensee during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection.

LPA did not review staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date. If staff files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

Page 2 of 4

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 197411187
VISIT DATE: 08/26/2019
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
Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 05/02/2019.

Menus are posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Lunch was reviewed for availability, quantity and appropriateness to children in care. Preschoolers are provided with breakfast for the AM session and lunch for the PM session by the Los Angeles Unified School District.

First Aid supplies were observed in the classroom. According to the Head Teacher and School Administrator Assistant there are no children in care at this time that required the administration of medication.

Medication: 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

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov. UPDATE: LPA advised Principal of the Mandated Reporter Child Care Training that became in effect January 1, 2018, and to maintain a copy of the certificate on file for each staff.

The following deficiencies listed on the attached LIC 809D are being cited in accordance with California Code of Regulations Title 22.

A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement form must be maintained in each child’s file immediately upon receipt from parent. Principal was provided with a copy of the parent Acknowledgement of Receipt of Licensing Reports Form during this visit. A copy of the Parent Notification Requirements was also provided to the Principal. Page 3 of 4

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 197411187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2019
Section Cited

1
2
3
4
5
6
7
1596.954- Carbon monoxide detectors required; inspection:Every licensed child day care center shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPA observation and interview with Principal who informed LPA that they did not have any carbon monoxide detector in the premises. This poses an immediate risk to the health and safety of children in care
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 197411187
VISIT DATE: 08/26/2019
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
The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00. Exit interview was conducted with Steve Salva, Principal, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

Page 4 of 4

SUPERVISOR'S NAME: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: CHEREMOYA AVENUE ELEMENTARY SCHOOL STATE PRESCHOOL
FACILITY NUMBER: 197411187
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/27/2019
Section Cited

1
2
3
4
5
6
7
101238 Buildings and Grounds:(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
8
9
10
11
12
13
14
This requirement is not met as evidenced by LPAs observation and interview with Principal RM 2 was missing electric outlet covers during the inspection. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
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: Adriana HernandezTELEPHONE: (323) 981-3362
LICENSING EVALUATOR NAME: Mireya GarciaTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2019
LIC809 (FAS) - (06/04)
Page: 6 of 6