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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197416586
Report Date: 09/13/2019
Date Signed: 09/13/2019 11:54:37 AM

COMPREHENSIVE INSPECTION
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:STANFORD PRIMARY CENTER CSPPFACILITY NUMBER:
197416586
ADMINISTRATOR:GOGUE, ROMERO C.FACILITY TYPE:
850
ADDRESS:3020 KANSAS AVENUE RM #2TELEPHONE:
(323) 563-9208
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:24CENSUS: 18DATE:
09/13/2019
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Teresa Garcia, PCC TeacherTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Fabiola Vasquez and Rita Ramos conducted an unannounced Annual Required Inspection. Upon arrival the Principal and Assistant Principal were both unavailable at the facility due to a meeting on this day. LPAs met with Teresa Garcia, Pre-School Collaborative Class (PCC) Teacher, who guided analysts on a tour of the facility both indoors and outdoors.

This is a preschool program that operates two sessions an AM and a PM session. This facility operates from Monday to Friday. The AM session operates from 7:50AM -10:30 AM and the PM session operates from 11:30AM -2:30 PM. All areas identified on this report were inspected. Upon arrival, the following staff were present during this inspection: Room 2: Staff #1, #2, #3, #4, and #5. During the inspection there were 18 preschoolers present.

Furniture and equipment were inspected for age appropriateness and good repair. Telephone service, heating, lighting and ventilation were evaluated. Children have their own cubby to store their belongings. Children in this facility do not nap. LPAs observed an Isolation area which is located in the Nurse's office for ill children to rest if necessary.

Age appropriate sinks and toilets were inspected for availability and good repair in all restrooms. General sanitation was observed. Availability of indoor drinking water was observed in classrooms. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible to children.


Per staff present, there are no poisons stored at the facility.

All kitchen areas/food preparation areas and food storage areas are kept clean and are free of litter, rubbish, rodents, and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Trash cans used to discard food have tight fitting lids that are kept on. ----------Page 1 of 3

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: STANFORD PRIMARY CENTER CSPP
FACILITY NUMBER: 197416586
VISIT DATE: 09/13/2019
NARRATIVE
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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.htm

LPAs advised the Teresa Garcia to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov.

The following deficiency listed on the attached deficiencies page is being cited in accordance with California Code of Regulations Title 22.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Exit interview was conducted with Teresa Garcia, PCC Teacher, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

------------Page 3 of 3

SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 3 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 CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: STANFORD PRIMARY CENTER CSPP
FACILITY NUMBER: 197416586
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/13/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/27/2019
Section Cited

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Employees or volunteers at day care center; immunization requirements; records; exemptions

The day care center shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person’s personnel record that
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is maintained by the day care center.

This requirement is not met as evidenced by LPAs observing that Staff #1 is missing proof of measles, Staff #3, #4, and #5 are missing proof of measles, pertussis, and influenza. This poses a potential health and safety risk to children 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) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:
DATE: 09/13/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/13/2019
LIC809 (FAS) - (06/04)
Page: 4 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 CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: STANFORD PRIMARY CENTER CSPP
FACILITY NUMBER: 197416586
VISIT DATE: 09/13/2019
NARRATIVE
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Outdoor playground equipment is in a safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard. Availability of outdoor drinking water was observed.

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. There is at least one person trained in CPR and Pediatric First Aid present during this inspection.

Children’s Records were reviewed for completeness; Inspection of required forms was made. LPAs issued the Children’s Record Review (LIC 857) to the PCC Teacher, Teresa Garcia during this inspection. In review of children’s records, files contain information including, but not limited to the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

LPAs also issued the Reviewed of Staff records (LIC 859) to the licensee during this inspection. The LIC 857 and the LIC 859 documents the staff and children’s files that were reviewed during this inspection. Staff present have proof of the AB 1207 Mandated Reporter Training certificate on file, however, did not have proof of immunization against measles, pertussis, and influenza.

Children's roster was reviewed and is current. Sign-In and Sign-Out sheets were reviewed. Children present were signed in. Disaster drill log was available, last drill was conducted on 09/121/2019.

Menus are posted for breakfast and Lunch in advance where it is visible by the child's authorized representative. Menus for the past 30 days are available upon request. Snacks were reviewed for availability, quantity and appropriateness to children in care. The facility provides AM and PM snack.

First Aid supplies were observed in the classroom in a container. According to PCC Teacher, medication is only administered to a child when accompanied with a doctor's note and is stored in the Nurse's office.

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SUPERVISOR'S NAME: Brandi VanOostenTELEPHONE: (323) 981-3439
LICENSING EVALUATOR NAME: Fabiola VasquezTELEPHONE: (323) 981-3350
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2019
LIC809 (FAS) - (06/04)
Page: 2 of 4