197411203-2-9-2022-30-CC-JLAO-CBGJVZ-20220209062357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197411203
Report Date: 02/08/2022
Date Signed: 02/09/2022 06:24:27 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:	PACE - ANDERSON HEAD START		FACILITY NUMBER:	197411203
ADMINISTRATOR:	NICOLE JOHNSON		FACILITY TYPE:	850
ADDRESS:	4130 W. 154TH STREET, RM. 6		TELEPHONE:	(310) 219-1173
CITY:	LAWNDALE	STATE: CA	ZIP CODE:	90260
CAPACITY:	18	CENSUS: 12	DATE:	02/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Davita Brown and Debbie Kahwaji		TIME COMPLETED:	03:55 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 2/8/2022 Licensing Program Analyst (LPA) Judy Laureano, conducted an unannounced Annual Required Inspection for the preschool license. LPA met with Director, Davida Brown and Debbie Kahwaji- Regional Site Director, and toured the facility indoors and outdoors. Days and hours of operation are Monday through Friday with an AM and PM classroom; AM- 7:30 a.m .to 1:30 and PM- 2:00 p.m. to 5:30 p.m. LPA arrived at facility while children were napping and observed three staff members providing care and supervision. During the visit, two additional staff members arrived, Regional Site Director and Teacher Assistant. During the visit, PACE maintenance Technician was also on site. There is no swimming pool or other bodies of water on the premises. There are no firearms or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible under the sink area secured with a safety latch. No poisons were observed during the inspection. Furniture and equipment are in good condition, free of sharp, loose or pointed parts. Playground equipment is in safe condition, free of sharp, loose or pointed parts. Currently facility is utilizing the elementary campus apparatus- preschool. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All toilets and hand washing facilities are in safe and sanitary operating condition. Floors in the facility are clean and safe. All kitchen, food preparation and storage areas are clean, free of litter/rubbish and free of rodents/vermin. All food is protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers have tight-fitting covers and are in good repair.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: PACE - ANDERSON HEAD START	FACILITY NUMBER: 197411203
	VISIT DATE: 02/08/2022

NARRATIVE

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Drinking water is available both indoors and outdoors. Areas around high climbing equipment, swings and slides have cushioning material to absorb falls. The facility is free of flies, insects and rodents. Facility has one or more functioning carbon monoxide detectors that meet statutory requirements.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Capacity and limitations as specified on the license are being maintained. At least one
person trained in CPR and Pediatric First Aid is present when children are at the facility.
The name of the child care center director or fully-qualified teacher designated to act in the director’s absence has been reported to the Department.

The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. All children are under supervision, including visual supervision, of a teacher at all times. Facility maintains a ratio of one teacher supervising no more than 12 children in care.

LPA reviewed a sample of children’s files and observed 10 files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis and measles and current documentation of completed mandated reporter training. LPA issued a Technical Advisory- HSC 1596.8662 (b)(1)- Mandated reporter training expired for Nancy Delgado. Menus are posted at least one week in advance where an authorized representative can view them. Facility provides copies of menus to parents on a monthly basis.

SUPERVISOR'S NAME: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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: PACE - ANDERSON HEAD START	FACILITY NUMBER: 197411203
	VISIT DATE: 02/08/2022

NARRATIVE

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LPA observed the PM classroom arrive at 2:00 p.m.- 14 children with 4 adults providing care and supervision.

Incidental Medical Services (IMS) are currently being provided. Licensee is aware that an IMS plan is required to be submitted to the licensing office if they provide any of these services. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link https://www.ada.gov/childqanda.htm.

LPA and Licensee discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies
are cited.

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: Maureen Neal	TELEPHONE: (424) 301-3042
LICENSING EVALUATOR NAME: Judy Laureano	TELEPHONE: (424) 301-3060
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC809 (FAS) - (06/04)

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