197416729-1-12-2023-54-CC-DGIS-CMZVML-20230112153343

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416729
Report Date: 01/12/2023
Date Signed: 01/12/2023 03:33:51 PM

Document Has Been Signed on 01/12/2023 03:33 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:	MIDDLETON PRIMARY CENTER LAUP		FACILITY NUMBER:	197416729
ADMINISTRATOR:	LAURA AVALOS		FACILITY TYPE:	850
ADDRESS:	2410 ZOE AVENUE -ROOM 1		TELEPHONE:	(323) 826-9533
CITY:	HUNTINGTON PARK	STATE: CA	ZIP CODE:	90255
CAPACITY:	24	CENSUS: 0	DATE:	01/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Laura Avalos, Facility Representative		TIME COMPLETED:	04:00 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	Licensing Program Analysts (LPA) Denise Gibbs conducted an unannounced annual required inspection at the above facility on 1/12/23 at 2:15PM. LPA met with Lorena Avalos, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program with two part time programs. Facility operating hours are Monday-Friday, AM, 7:50am-10:50am and PM, 11:50pm-2:50pm. Currently facility only has AM children enrolled. This facility is located on the campus of a primary center which also houses Kindergarten and first grade elementary students. Licensed preschool is located in Room #1. There were no children and one staff present when LPA arrived. 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. LPA observed required posted documentation in the classroom which included, Facility License, Publication (PUB) 393- Notification of Parent Rights, Licensing Form (LIC) 610- Facility Disaster Plan, PUB 269- Child Passenger Restraint System, and LIC 613A- Notification of Parent’s Rights and breakfast/lunch menu. Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 12/16/22. Al items observed. LPA reviewed Sign In/Out sheets located in the classroom. All children who attended the AM session were signed in and out with date, time and full signature of representative. LPA toured Room #1. Classrooms had furniture in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classrooms were clean and safe. Rugs were observed to be flat on the ground ----------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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: MIDDLETON PRIMARY CENTER LAUP	FACILITY NUMBER: 197416729
	VISIT DATE: 01/12/2023

NARRATIVE

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to avoid tripping hazards. Water is made readily available via water bottles. There is a water fountain outside of the classroom where children can refill water bottles There are currently no children with medication. Children have cubbies to store personal belongings separate from each other. Children do not nap at facility because they are part time.

LPA toured the children’s restroom. Restroom waiver was observed to be posted in the classroom. Restrooms are located outside the classroom, across the hall from the preschool class. Per staff, children do not commingle with other programs while in the restroom. LPA observed operable toilets and sinks. Bathroom was observed to be sanitary and free of hazards.

LPA toured the outdoor play area. LPA observed operable water fountains outdoors for children to drink freely. The outdoor area has material and equipment for children to use. LPA observed shaded area over activity benches. The climbing structure has required padding to absorb fall, that is kept in good condition. The facility has a waiver for shared outdoor space with the elementary students. Staggered outdoor schedule posted.

LPA toured kitchen at facility. Facility provides breakfast and lunch. Food is not cooked at the facility. Prepackaged food is brought from the neighboring elementary school. Extra food is discarded. Food Storage area was observed to be clean, free of litter, insects and rodents. Cleaning supplies are stored separate from the food. Carbon monoxide detector is wired with facility smoke and fire alarm.

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

Staff records were reviewed for approved Pediatric First Aid and CPR certification for at least one staff member, LIC-501: Personnel Record, LIC 9052- Employee Rights, Proof of immunization's 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.

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SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

Page: 2 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: MIDDLETON PRIMARY CENTER LAUP	FACILITY NUMBER: 197416729
	VISIT DATE: 01/12/2023

NARRATIVE

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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

No deficiencies will be given today 1/12/23.

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 Facility Representative, Lorena Avalos.------------------PAGE 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

LIC809 (FAS) - (06/04)

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