197414042-3-3-2022-30-CC-DLOE-CC6PMU-20220303102657

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197414042
Report Date: 03/03/2022
Date Signed: 03/03/2022 10:27:34 AM

Document Has Been Signed on 03/03/2022 10:27 AM - 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	CCRC HEAD START - SEPULVEDA		FACILITY NUMBER:	197414042
ADMINISTRATOR:	FIDES-LEAH SOTO		FACILITY TYPE:	850
ADDRESS:	15435 RAYEN STREET		TELEPHONE:	(818) 892-0728
CITY:	SEPULVEDA	STATE: CA	ZIP CODE:	91343
CAPACITY:	64	CENSUS: 24	DATE:	03/03/2022
TYPE OF VISIT:	Case Management - COVID-19	UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Fides-Leah Sotto		TIME COMPLETED:	10:40 AM

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On 03/03/2022 at 8:07 am, Licensing Program Analyst (LPA) Deborah Lowe conducted an unannounced Case Management – COVID-19 inspection for the purpose of following up on 2 Unusual Incident Reports (UIR) submitted on 01/18/2022 and 1/28/2022. LPA Lowe met with Director, Fides-Leah Sotto, who toured LPA through the inside and outside of the facility. LPA observed 24 children in care with 5 staff. Staff present were observed to have their criminal record clearances.

According to the UIR, on 01/18/2022 - 2 staff members were reported as testing positive for COVID-19. At the time staff tested positive children were still on winter break. Children returned to facility from winter break on 1/24/2022.

According to the UIR, on 01/28/2022 – 1 child was reported as testing positive for COVID-19.

Director stated all of the children and staff who were reported positive COVID have all isolated and have since all returned to the facility. LPA Lowe observed the child who was reported with positive COVID to be in attendance during visit. The staff who tested positive were absent from facility during visit.

At 8:10 am LPA Lowe observed children drop off, LPA observed staff taking children temperature and reviewing a tablet with parent. Director stated the tablet was staff verifying the parent completed the online health assessment. LPA Lowe reviewed Daily Health Card for staff and children.

Starting at 8:20 am during facility tour LPA Lowe observed the children having snack within the classrooms. LPA observed staff wearing masks, soap and paper towels were observed to be available at all handwashing sinks and hand sanitizer available in each room.

At 9:10 am LPA Lowe observed on site COVID testing provided by testing facility. Children were observed to be wearing masks.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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: CCRC HEAD START - SEPULVEDA	FACILITY NUMBER: 197414042
	VISIT DATE: 03/03/2022

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LPA Lowe observed COVID-19 signage throughout the facility for mask wearing, washing hands, and stay safe 6 feet apart. LPA Lowe observed two drop off/ pickup gates. Director stated room #1 and room #2 gate is designated at the front gate and room #3 and room #4 are designated at the back gate to ensure social distancing. Both gates were observed with visitor sign stating, “Strict Visiting Rules Are In Place”. LPA observed visitors log.

LPA Lowe observed facility supply of PPE COVID supplies as gloves, hand sanitizing wipes, cleaning wipes, children mask, adult masks, and thermometers.

LPA Lowe discussed with Director current COVID-19 resources and guidance.

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

An exit interview was conducted and a copy of this report (LIC 809) and Notice of Site Visit were provided to Director, Fides-Leah Sotto.

SUPERVISOR'S NAME: Karren Starks	TELEPHONE: (434) 301-3069
LICENSING EVALUATOR NAME: Deborah Lowe	TELEPHONE: (424) 301-3016
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC809 (FAS) - (06/04)

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