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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414108
Report Date: 03/12/2020
Date Signed: 03/12/2020 12:40:23 PM

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:SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTERFACILITY NUMBER:
197414108
ADMINISTRATOR:KAE CONNORSFACILITY TYPE:
840
ADDRESS:2114 PONTIUS AVENUETELEPHONE:
(310) 445-8993
CITY:LOS ANGELESSTATE: CAZIP CODE:
90025
CAPACITY:12CENSUS: 7DATE:
03/12/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kae Connors, DirectorTIME COMPLETED:
12:55 PM
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On 3/12/2020 at 10:20AM, Licensing Program Analyst Denise Miranda met with Kae Connors, Director and discussed the purpose of the visit. LPA Miranda verified that all adults present have obtained criminal record clearances and are associated to the facility. LPA Miranda also reviewed the sign in and sign out sheet to verify the census.

The preschool serves children ages 5 to 6-year old. This is a full day program and operates from 7:00 AM to 7:00 PM. During the visit LPA observed that there are 7 children present, with 2 Teachers.
A walk through of the room space was conducted, the space was found to be clean and free from any potential hazards. Furniture was found to be in good repair and age appropriate. LPA observed adequate lighting and ventilation. Drinking water is readily available in the classrooms. Isolation area for sick students is beside to the Director’s office. LPA observed adequate arrangements for isolation and care of ill children.
The bathroom and toileting areas were inspected, LPA observed adequate toilets and sinks to accommodate the facility’s capacity. Toilets flush properly, toilet and sinks are reachable by the children in care. The restroom has adequate toilet paper and paper towels available. The bathroom was found to be clean. There is adequate lighting/ventilation in the bathroom area.
The facility provides am/pm snacks and parents provides the lunch. Food and snacks were reviewed for availability, quantity and appropriateness to children in care. A review of cleaning and food supply storage areas was made. All storage containers, including moveable bins were observed with cover and in good repair.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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 3
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: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER
FACILITY NUMBER: 197414108
VISIT DATE: 03/12/2020
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Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness, free of sharp, loose or pointed parts. LPA observed shade area, drinking water and fencing were inspected. No body of water.

The facility has one or more functioning fire extinguishers, smoke detectors that meet statutory requirements. LPA observed a fully charged 2A10BC fire extinguisher). Facility was observed to be operating within the conditions, limitations, and capacity specified on the license.


Outdoor equipment was inspected for safety, cushioning material, good repair and age appropriateness. Required shade, drinking water and fencing were inspected. Play area was inspected for hazards and inaccessibility to bodies of water. The facility has one or more functioning fire extinguishers, smoke detectors that meet statutory requirements. Facility was observed to be operating within the conditions, limitations, and capacity specified on the license. At least one person was observed to be trained in CPR and Pediatric 1st Aid. Staff #1 has completed the training for Adult and Pediatric CPR AED/ Basic First Aid (expires on 05/2021).
FACILITY IS NOT CURRENTLY PROVIDING IMS. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. 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.html
Requirements for disaster drills and mandatory documentation for both children and staff files were discussed. The Director was informed of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541 Email Address: childcareadvocatesprogram@dss.ca.gov The Director was advised how to access forms and Regulations for Child Care Center online at www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. The Director was advised that inaccessibility of hazards must be constantly reassessed depending on the children in care.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
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: SAMUEL GOLDWYN FOUNDATION CHILDREN'S CENTER
FACILITY NUMBER: 197414108
VISIT DATE: 03/12/2020
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Licensing must have the facility’s phone number at all times; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco on the premises. Assembly Bill 633: Upon receipt of a citation for a Type A Deficiency, the director shall post the licensing report for 30 days in addition to the Notice of Site Visit & provide copies of the licensing report (LIC 809D/9099D) to parents/guardians of children in care at the facility by the close of business the following day or the next day child returns to the facility. The same report must be provided to parents/guardians of children newly enrolled at the facility during the next 12 months & licensee will obtain a signed Acknowledgement of Licensing Reports (LIC 9224) from parent/guardian & place it in each child's file. Senate Bill 792: This bill, commencing September 1, 2016, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. New Immunization Requirement: Law enacted by SB 277, beginning January 1, 2016, personal beliefs exemptions will no longer be an option for the vaccines that are currently required for entry into child care or school in California. Personal beliefs exemptions already on file will remain valid until the child reaches the next immunization checkpoint. New Appeal Process: A licensee may file an appeal, in writing 15 business days from the date of receiving the penalty assessment. All appeals must be sent to: California Department of Social Services Community Care Licensing Division |300 N. Continental Blvd. Suite 290-A |El Segundo, CA 90245 Assembly Bill 1207: California Child Care Workers; Mandated Training Requirement. Beginning January 1, 2018, all licensed providers, applicants, directors and employees must complete Mandated Reported Training prior to March 30, 2018 and renew training every two years at: www.mandatedreporterca.com. Nutrition Requirement: Beginning January 1, 2016, AB 290 will require for each new license issued, at least one director or teacher at each child care center or family child care home to have at least one hour of training in the importance of childhood nutrition. This applies to anyone submitting a new application, relocating their facility, selling their facility or transferring their license. Please note this training cannot be completed online or by home study programs. The training must be taken from an Emergency Medical Services Authority (EMSA) approved training program OR an accredited college or university. During this inspection LPA provided copy of the following forms: LIC311A Record to Maintained at the Facility – Child Care Center. Title 22 Food 101227, Title 22 Director provided copy of update Children Roster. An exit interview was conducted and a copy of this report along with the Notice of Site Visit were provided to Kae Connor, Director.
SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3077
LICENSING EVALUATOR NAME: Denise MirandaTELEPHONE: (424) 301-3055
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2020
LIC809 (FAS) - (06/04)
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