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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197412826
Report Date: 04/18/2024
Date Signed: 04/18/2024 01:51:31 PM


Document Has Been Signed on 04/18/2024 01:51 PM - It Cannot Be Edited

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:STONEHURST ELEMENTARY SCHOOL STATE P.S.FACILITY NUMBER:
197412826
ADMINISTRATOR:IMPERIALE, JILLFACILITY TYPE:
850
ADDRESS:9851 STONEHURST AVENUE RM. 2TELEPHONE:
(818) 767-8014
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:24CENSUS: 14DATE:
04/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Pricipal Ruth KimTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Roxana Lopez and Saul Valenzuela conducted a Case Management Deficiencies visit on this date to address deficiencies revealed during a Case Management Lead Inspection. Census was taken.

LPA's initially arrived at the facility at 9:40 am and were taken to the classroom by the office manager- who stated that teacher was on break. When LPA's arrived to the playground they observed 1 Teacher- Aide out of ratio with 14 children and no qualified teacher present. This is an immediate risk for the health and safety of children. Teacher, walked into the classroom and informed LPA's that they still had 5 minutes left on their break. LPA's advised that a fully qualified teacher had to present when taking her break. Per teacher, they have shared that concern but do not have extra support. At 10:20 am LPA's met Principal Ruth Kim, Per Principal, they have 2 adults for 14 children- and was not sure if they are a Title 5 school. Principal stated that when teacher goes on break the Pals teacher (classroom next door) should have the door open and Teacher will supervised from there. LPA's advised that children have to be directly supervised by a fully qualify teacher.

During inspection LPA's advised Principal to submit a complete packet with their qualifications to the department including orientation and updated LIC 308.

Based on LPA observations and records review, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code of Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety-
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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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 4


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: STONEHURST ELEMENTARY SCHOOL STATE P.S.
FACILITY NUMBER: 197412826
VISIT DATE: 04/18/2024
NARRATIVE
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LPA Roxana Lopez informed Facility Representative Ruth Kim that this report dated 4/18/2024 document(s) 1 Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Also, LPA Roxana Lopez informed the Licensee to provide a copy of this licensing report dated 4/18/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Facility Representative Ruth Kim

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4
Document Has Been Signed on 04/18/2024 01:51 PM - It Cannot Be Edited

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: STONEHURST ELEMENTARY SCHOOL STATE P.S.
FACILITY NUMBER: 197412826

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
101216.2(e)

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101216.2 Teacher Aide Qualifications and Duties: (e)An aide shall work only under the direct supervision of a teacher. This requirement is not met as evidenced by:
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Per Principal they will have Preschool class combined with the Pals class in the yard during breaks to have a teacher present. Principal will contact the ECC Director to work on a compliance plan and submit plan to LPA via emai by 05/03/2024
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Based on observation the licensee did not comply with the section cited above in that Teacher aide was observed in the playground with 14 children and no qualify teacher. Which poses/posed a potential health, safety or personal rights risk to persons in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 2 of 4


Document Has Been Signed on 04/18/2024 01:51 PM - It Cannot Be Edited

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: STONEHURST ELEMENTARY SCHOOL STATE P.S.
FACILITY NUMBER: 197412826

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2024
Section Cited
CCR
101216.3(a)

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101216.3 Teacher-Child Ratio (a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below. This requirement is not met as evidence by:
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Per Principal they will have Preschool class combined with the Pals class in the yard during breaks to have a teacher present and be in ratio. Principal will contact the ECC Director to work on a plan to keep facility in ratio at all times. Plan will be submited via email by 5/3/2024.
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Based on observation the licensee did not comply with the section cited above in that Teacher aide was observed to be out of ratio in the playground with 14 children. Which poses/posed a health, safety or personal rights risk to persons in care.
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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: Brandi VanOostenTELEPHONE: (323) 981-3365
LICENSING EVALUATOR NAME: Roxana LopezTELEPHONE: (323) 854-5073
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4