197416919-5-27-2022-54-CC-DGIS-CETVNN-20220527163525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197416919
Report Date: 05/27/2022
Date Signed: 05/27/2022 04:35:33 PM

Document Has Been Signed on 05/27/2022 04:35 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:	SPIRIT CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	197416919
ADMINISTRATOR:	KEENA TAYLOR		FACILITY TYPE:	850
ADDRESS:	4061 WEST WASHINGTON BOULEVARD		TELEPHONE:	(323) 737-2467
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY:	60	CENSUS: 30	DATE:	05/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Keena Taylor, Facility Representative		TIME COMPLETED:	04:50 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 5/27/22 at 1:45 PM. LPA met with Keena Taylor, Facility Representative (FR) who guided analysts on a tour of the facility. This is a preschool program which consists of five classrooms, Dragonfly #1 and #2, Lady Bug, Bumble Bee, and Butterflies. Facility operation hours are Monday to Friday from 6:45 AM to 6:00 PM. This facility houses an early Intervention program (referred by Regional Center). This facility is also associated with Spirit Early Intervention Program (Infant center) #198013696 housed at another location. There were 30 children and eight staff present when LPA arrived. Facility capacity is in compliance with license capacity and Title 22 ratio guidelines. All individuals present have obtained a criminal record clearance. LPA toured All classrooms. 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. LPA did not observe any tripping hazards. Water is made readily available by via pitcherS and cups provided by the facility. Per FR, children's medication is stored in the classroom on a high shelf. LPA observed storage, expiration date and documentation for medication. Children have cubbies to store personal belongings separate from each other. LPA observed children napping on cots during visit. Sheets are provided by facility and washed weekly. Blankets are brought from home and washed weekly. LPA toured the children’s restrooms. Restrooms were observed to be safe and sanitary with operable sinks and toilets. LPA observed that there is a waiver on file for stagger play. Outdoor area was observed to have age appropriate toys and material for children, free of loose, sharp, and/or pointed parts. ---------------------PAGE 1

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: SPIRIT CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197416919
	VISIT DATE: 05/27/2022

NARRATIVE

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LPA observed required cushioning under climbing equipment to absorb fall. Shade was observed throughout the outdoor area. Water pitchers and cups were observed readily available for children.

LPA observed required posted documentation in the facility entrance, which included, Facility License, waiver for outdoor play, 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. All documents were observed.

Facility records were reviewed for LIC 9040- Facility Roster, 9148- Earthquake Preparedness form, Daily schedule and Disaster drill log, last drill conducted on 4/22/22. All documents were observed.

LPA reviewed Sign In/Out sheets located outdoors next to the parent check in stations. All children present were signed in with date, time and full signature of the child's representative.

LPA toured the kitchen located adjacent to the Dragonfly #1 classroom. Facility provides Breakfast, AM snack, PM snack and lunch. Food is prepared at facility. Kitchen was observed to be clean, free of litter, insects and rodents. Trash cans for solid waste have tight fitting lids. Cleaning supplies are stored separate from the food. Per FR carbon monoxide detector is combined with facility smoke and fire alarm system.

Children’s records were reviewed for Licensing Form (LIC) 700 Emergency Card, Immunization Records, 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 complete.

Staff records were reviewed for approved Pediatric First Aid and CPR certification for at least one staff member on site, LIC 9052- Employee Rights, LIC 501- Personnel Record, LIC 503- Health Screening Report, LIC 508- Criminal Record Statement, 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 and current Mandated Reporter Training Certificate. Documents were discussed.

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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: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

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: SPIRIT CHILD DEVELOPMENT CENTER	FACILITY NUMBER: 197416919
	VISIT DATE: 05/27/2022

NARRATIVE

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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.

LPA observed that facility is implementing COVID-19 precautions and procedures as recommended by the Department of Public Health.

Incidental Medical Services (IMS):
This facility provides Incidental Medical Services- IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personal, and administrative records. For IMS information see Evaluator Manual – Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. 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 5/27/22.

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.

Facility representative was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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, Keena Taylor ----PAGE 3

SUPERVISOR'S NAME: Trevino Cochran	TELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Denise Gibbs	TELEPHONE: (323) 558-2794
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022

LIC809 (FAS) - (06/04)

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