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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414609
Report Date: 03/16/2022
Date Signed: 03/16/2022 05:07:16 PM


Document Has Been Signed on 03/16/2022 05:07 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, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245



FACILITY NAME:JOHN ADAMS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
197414609
ADMINISTRATOR:SUSAN SAMARGEFACILITY TYPE:
850
ADDRESS:2320 17TH STREETTELEPHONE:
(310) 399-5865
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:65CENSUS: 23DATE:
03/16/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:REHAM DABASHTIME COMPLETED:
02:00 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 3/16/2022, Licensing Program Analyst (LPA) Loyce Phillips, conducted a case management inspection to follow up on COVID-19 Positive Cases. LPA met with Assistant Director, Reham Dabash conducted a facility risk assessment, toured the facility and took a census. Upon arrival, there were 23 children and 4 staff present today at the facility. LPA toured 2 classrooms, children and staff restrooms, staff lounge and the outdoor play area.

LPA observed the front entry displaying COVID-19 signs/posters and hand sanitizer dispensers, clean/dirty pens, gloves. All restrooms were functioning and fully stocked with soap and paper towels. The children high touched materials and supplies are kept separate in individual zip lock bags for personal use. Each child has individual cubbies for their personal belongings.

During the visit LPA and Assistant Director discussed the following:

Arrival Procedures - Children, staff and visitors must answer a screening questionnaire before entering the facility. Hand sanitizer and hand washing is required before entering the classrooms.

Face Mask - All children and staff are strongly encourage to continue to wear face mask daily while indoors.

Isolation area - The isolation area is located outdoor near classroom 1. A designated staff will stay with the child until the parent arrives. The isolation restroom is near classroom 1 for children with symptoms or signs of COVID-19.

809 C

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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 2


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: JOHN ADAMS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 197414609
VISIT DATE: 03/16/2022
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
Cleaning and Disinfecting - The facility is cleaned every evening. The outdoor area is cleaned and disinfected. When choosing cleaning products, use products approved by Environmental Protection Agency list.

PPE - The facility has a sufficient amount of PPE supplies. Supplies are ordered from the School District.

Reporting Requirements – LPA explained and reminded Assistant Director to report all COVID-19 positives cases to Department of Public Health. When reporting Unusual Incidents, call CCLD within 24 hours and submit Unusual Incident Report within 7 days.

No deficiencies are being cited in accordance to Title22 of the California Code of Regulations and/or Health & Safety Codes.

An exit interview was conducted, a copy of this report and notice of site visit were provided to Reham Dabash.

SUPERVISOR'S NAME: Peter FloresTELEPHONE: (424) 301-3063
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (424) 301-3206
LICENSING EVALUATOR SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2