197415232-6-9-2022-54-CC-RDEO-CF8QNY-20220609121955

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197415232
Report Date: 06/09/2022
Date Signed: 06/09/2022 12:20:23 PM

Document Has Been Signed on 06/09/2022 12:20 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	THERESA HUGHES ELEMENTARY SCHOOL		FACILITY NUMBER:	197415232
ADMINISTRATOR:	ADRIANA CORTEZ		FACILITY TYPE:	850
ADDRESS:	4242 CLARA STREET, K-4		TELEPHONE:	(323) 560-4422
CITY:	CUDAHY	STATE: CA	ZIP CODE:	90201
CAPACITY:	24	CENSUS: 9	DATE:	06/09/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Teacher - Maria Alcazar		TIME COMPLETED:	12:35 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	Licensing Program Analyst (LPA) Randy Derraco conducted an unannounced required one year inspection to the above facility on 06/09/22 at 09:45 AM. LPA was met by Maria Alcazar, teacher, who guided analyst on a tour of the facility. Per teacher, principal was unavailable due to end of year commencement. This is a California State Preschool Program that operates Monday-Friday from 8:00AM-11:00AM and from 12:00PM-3:00PM. Per teacher, the program only offers half day class There were nine children and three staff present when LPA arrived. Facility is in compliance with license capacity and Title Five ratio guidelines. All individuals present have obtained a criminal record clearance or criminal record exemption as a condition of employment with the Los Angeles Unified School District. The center consists of one classroom. The classroom had furniture in good condition, free of loose, sharp and/or pointed parts. The floor and surfaces in the classroom was clean and safe. Rugs were observed to be flat on the ground to avoid tripping hazards. Water is made readily available via water bottles brought from the children's home. Per teacher, if a child forgets to bring a water bottle, one is provided by the center. . Per teacher, children's medication is stored with the on campus nurse in the main office. Per teacher, each class is 3 hours long and children do not nap. LPA toured the children’s restroom. Restroom was observed to be safe and sanitary with operable sinks and toilets. LPA toured the outdoor play area. Outdoor area were observed to have perimeter fencing. LPA observed required cushioning under climbing structure to absorb fall. Shade was observed throughout the outdoor area. Water bottles are taken outdoors for children in care. LPA observed required posted documentation in the main entrance of the classroom which included, Facility (page 1 of 3)

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: THERESA HUGHES ELEMENTARY SCHOOL	FACILITY NUMBER: 197415232
	VISIT DATE: 06/09/2022

NARRATIVE

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License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, LIC 613A- Notification of Personal Rights. All items were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedules and Disaster drill log. Per teacher, disaster drills are conducted once a month and logged with the principal. LPA was unable to view the disaster drill log at time of visit.

Teacher advised LPA that meals are prepared in the cafeteria and then brought into the classroom during meal time. During inspection, LPA observed assistant bring in a take home lunch for children departing for the day. Per teacher, the morning class gets breakfast and a take home lunch; the afternoon class gets a lunch and a take home home snack.

LPA reviewed Sign In/Out sheets located in a storage cabinet inside the classroom. All children present were signed in with date, time and full signature of the parent or guardian. Due to COVID-19 precautions, parents are not entering the facility. Children are dropped off and picked up at the main entrance. A digital daily pass (approved child health assessment) is scanned for added precaution.

Children’s records were reviewed for Emergency Card, Immunization Records, Licensing Form (LIC) 627- Consent for Medical Treatment, LIC 995 Notification of Parents’ Rights, LIC 701- Physician’s Report, LIC 613A- Personal Rights, and signed Admissions Agreement. All documents were complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification, LIC 9052- Employee Rights, Proof of immunization against measles, pertussis and influenza or influenza declination, TB clearance or risk assessment, LIC 9108- Statement Acknowledging Requirement to Report Child Abuse, Transcripts or Permit and current Mandated Reporter Training Certificate. Documents were not observed in the staff files. LPA advised teacher that technical violations will be issued as a reminder to have documents available for review. LPA left LAUSD Staff Files checklist with teacher to review.

During inspection all children were observed to be treated with dignity and respect, they were observed to be receiving safe, healthful and comfortable accommodations, furnishings and equipment, and free from
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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: THERESA HUGHES ELEMENTARY SCHOOL	FACILITY NUMBER: 197415232
	VISIT DATE: 06/09/2022

NARRATIVE

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corporal and/or unusual punishment. LPA observed that facility still is implementing COVID-19 precautions and procedures as required by Los Angeles Unified School District and the Department of Public Health.

Incidental Medical Services (IMS):
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a plan for providing 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 Center and the ADA, available at: http://www.ada.gov/childqanda.htm

Based on the LPA's observations and records review no deficiencies will be cited today 06/09/22

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the teacher Maria Alcazar.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Randy Derraco	TELEPHONE: (323) 981-3431
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC809 (FAS) - (06/04)

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