197416733-5-4-2022-54-CC-DGIS-CE4QPF-20220504122041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416733
Report Date: 05/04/2022
Date Signed: 05/04/2022 12:20:49 PM

Document Has Been Signed on 05/04/2022 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:	HOOPER AVENUE PRIMARY CENTER CSPP		FACILITY NUMBER:	197416733
ADMINISTRATOR:	SHAW, MICHAEL J.		FACILITY TYPE:	850
ADDRESS:	1280 EAST 52ND STREET-ROOM 7		TELEPHONE:	(323) 233-5866
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90011
CAPACITY:	24	CENSUS: 6	DATE:	05/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Roslyn Simpson, Facility Representative		TIME COMPLETED:	12:30 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 5/4/22 at 10:00 AM. LPA met with Rosyln Simpson, Facility Representative (FR) who guided analysts on a tour of the facility. There were six children and one staff present when LPA arrived. Facility capacity is in compliance with license 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. This is a State Preschool housed with Transitional Kindergarten and Kindergarten elementary students. Wavier is posted for shared outdoor space and shared restroom use. LPA observed that children are not commingling. This facility provides and AM program 8:00AM-11:00AM and a PM program 12:00PM-3:003m. Children do not nap at facility. LPA observed required posted documentation which included, Facility 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 and Lunch/Snack Menu. Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 4/18/22. LPA toured Classroom (Room 7). Classroom had furniture in good condition, free of loose, sharp and/or pointed parts. The floors and surfaces in the classroom were clean and safe. Rugs were observed to lay flat on the ground to avoid tripping hazards. Water is made readily available by via water bottles that child can refill as needed throughout the day. Per FR, there are currently no children with medication in this facility. Children have cubbies to store personal belongings separate from each other. ---------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: HOOPER AVENUE PRIMARY CENTER CSPP	FACILITY NUMBER: 197416733
	VISIT DATE: 05/04/2022

NARRATIVE

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LPA reviewed Sign In/Out sheets located in the classroom All children present were signed in with date, time and full signature of the child's representative. Due to COVID-19 precautions parents do not enter the facility. A digital daily pass (approved child health assessment) is scanned and the child is dropped off.

LPA toured the children’s restrooms. Restrooms were observed to be safe and sanitary with operable sinks and toilets. Waiver on file for shared restroom.

LPA toured the outdoor play area. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. LPA observed required cushioning under climbing structure to absorb fall. Shade was observed throughout the outdoor area via large trees and water was observed to be readily available via water fountains and water bottles. Waiver on file for shared outdoor space. Children have scheduled time to use the yard.

LPA toured the kitchen located adjacent the outdoor space. Facility provides AM snack and PM snack. Food is not cooked at facility. Prepackaged food is delivered. No food is stored in the kitchen. Extra food sent home with children. Kitchen was observed to be clean, free of litter, insects and rodents. LPA observed trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food.

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 files reviewed were complete.

Staff records were reviewed at 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. File was complete.

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 corporal and/or unusual punishment.
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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: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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: HOOPER AVENUE PRIMARY CENTER CSPP	FACILITY NUMBER: 197416733
	VISIT DATE: 05/04/2022

NARRATIVE

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LPA observed that facility 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 5/4/22.

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 Facility Representative Rosyln Simpson.

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC809 (FAS) - (06/04)

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